Calcification air and thromus in coronary artery

1. Each one a Cat in
Coronary artery
Calcification, Air and thrombus

2. CAT
C=CALCIFICATION A=AIR EMBOLISM T=THROMBUS

3. CALCIFICATION

4. The Disrupt
CAD II Study
• In patients with severe CAC who require
coronary revascularization, IVL was safely
performed with high procedural success and
minimal complications and resulted in
substantial calcific plaque fracture in most
lesions.

5. A=AIR
EMBOLISM

6. Epstein and Plesset : mathematical model
• Epstein and Plesset were the first to use their mathematical model to
determine the behavior and dissolution of microbubbles in a solution

7. Explanation of abbreviations
• R=bubble radius
• t=time
• DG=gas mass diffusivity in the fluid
• B=universal gas constant
• MG=molecular weight of the gas
• C0=bulk dissolved gas concentration
• Csat=saturated concentration of the dissolved gas
• Pamb=ambient pressure
• σB =the surface tension of the bubble
• T=temperature

8. Protocol for Managing Coronary Air Embolism
• Prompt detection
• Immediately administer 100% O2
• Rapid IV fluids
• Temporary pacemaker placement
• Rapid groin access (if initial radial approach) or second (contralateral)
femoral arterial access for IABP or Impella placement
• Heparin 70 units/kg bolus and ACT q20 min
• Atropine
• phenylephrine for bradycardia and hypotension
• ACLS protocol

9. • Repeat angiography of (culprit) coronary artery with low-osmolar
ionic contrast — lowest volume to define anatomy, TIMI flow and air
embolus (no left ventricular [LV] gram) with interventions (at the
discretion of the physician)
• Bedside immediate echo
• Usual post percutaneous coronary intervention (PCI) monitoring or
hemodynamic-guided treatment for cardiogenic shock care,
depending on clinical situation
• CT or MRI brain if cerebrovascular accident (CVA) suspected (embolic)

10. T=THROMBUS

11. T=THROMBUS
• The use of embolic
protection devices is
indicated for saphenous vein
graft interventions (1)
•
• Xenogiannis I., Tajti P., Hall
A.B., et al. (2019) Update
on cardiac catheterization
in patients with prior
coronary artery bypass
graft surgery. J Am Coll
Cardiol Intv 12:1635–1649.

12. T=Thrombus
• but not for acute coronary
syndromes because of a lack of
benefit in prior randomized
controlled trials (2)
• Stone G.W., Webb J., Cox D.A., et
al. (2005) Distal microcirculatory
protection during percutaneous
coronary intervention in acute
ST-segment elevation myocardial
infarction: a randomized
controlled trial. JAMA 293:1063–
1072.

13. Remain
prepare for
your next
case
• Calcification ,air ,thrombus
• Inside coronary ,each is a cat
• A cardiologist don’t run away
• Fight like Ganesh’s talent rat