FFR with St. Jude System
•Download as PPTX, PDF•
15 likes•1,733 views
FFR is a technique used during coronary catheterization to measure pressure differences across a coronary artery stenosis to determine if it is restricting blood flow. FFR provides an invasive test to estimate the effects of a narrowed blood vessel in real-time without providing information on plaque morphology. Medications like adenosine are administered to increase the heart's workload and detect ischemia during FFR testing. Significant stenoses are considered less than 0.80 on the FFR scale while readings above 0.80 are not generally deemed significant obstructions.
Report
Share
Report
Share
Recommended
Rotablation
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Management of no reflow
No-reflow occurs when there is a lack of reperfusion to the myocardium after successful coronary recanalization and is defined as inadequate perfusion without angiographic evidence of vessel obstruction. It occurs in 0.6-3.2% of PCI cases and is associated with increased risk of LV dysfunction, remodeling, arrhythmias, heart failure and cardiac rupture. Diagnosis is typically done using myocardial contrast echocardiography or cardiac MRI. Treatment focuses on improving perfusion and includes vasodilators like adenosine, antithrombotics, mechanical strategies like thrombectomy, and preventing no-reflow through measures like pre-conditioning.
Pressure, Damping and Ventricularization_Crimson Publishers
This document discusses pressure changes that can occur during coronary angiography, specifically damping and ventricularization. Damping is defined as a significant decrease in pressure at the coronary ostium when the catheter is placed, accompanied by the disappearance of pressure waveforms, suggesting no antegrade flow. Ventricularization occurs when blood circulates within a coronary artery like a closed system, deforming the aortic pressure waveform. The document emphasizes the importance of the operator recognizing abnormal pressure changes to avoid complications, and provides solutions like catheter replacement or intracoronary nitroglycerin to address issues.
Coronary Angiography - Views - Dr Hafeesh Fazulu - PIMS.pptx
1) The document discusses various angiographic projections used to visualize the coronary arteries during coronary angiography. It provides 10 possible standard views and describes the optimal views for visualizing different coronary artery segments.
2) Tips are provided on how to learn and remember the different views using props like wires and bottles. Terminologies used in angiography and positioning of the image intensifier are also explained.
3) Chamber views used during left ventriculography are demonstrated in the right anterior oblique and left anterior oblique projections. A demonstration of the views is provided using a 3D anatomy atlas.
Stent thrombosis
Stent thrombosis is a rare but devastating complication occurring in less than 1% of patients within 30 days of stenting and 0.2-6% annually afterwards. It is associated with higher thrombus burden and less procedural success, resulting in higher rates of death, recurrent heart attack, and recurrent stent thrombosis. Risk factors include stent-related issues like early versus late thrombosis, procedure-related issues like incomplete apposition or expansion, vessel-related issues like long lesions or small vessel size, and patient-related issues like diabetes, impaired heart function, renal disease, or non-compliance with dual anti-platelet therapy. Management depends on thrombus burden grade, with direct angioplasty and stenting for small burdens and
OCT in coronary PCI
This document discusses optical coherence tomography (OCT) in coronary artery disease. It provides an overview of OCT, including its history and clinical evidence. It then outlines how to perform an OCT study and presents an algorithmic approach to interpreting OCT images, including assessing plaque morphology, stent sizing and apposition. The document discusses several clinical applications of OCT, such as evaluating acute coronary syndrome, plaque vulnerability, and stent failure. It also reviews limitations and future directions of OCT, including hybrid OCT/IVUS catheters and the use of artificial intelligence.
Coronary lesion assessment
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
No reflow and slow flow phenomenon during pci
This document discusses strategies and prevention of slow flow and no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion through a coronary artery without mechanical obstruction. No-reflow occurs in 8-11% of primary PCIs and is associated with worse clinical outcomes. The pathophysiology involves distal embolization, ischemic injury, reperfusion injury, and individual patient susceptibility. Preventing no-reflow requires reducing thrombus burden, ischemia time, reperfusion injury through anti-inflammatory drugs, and addressing risk factors like diabetes.
Recommended
Rotablation
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Management of no reflow
No-reflow occurs when there is a lack of reperfusion to the myocardium after successful coronary recanalization and is defined as inadequate perfusion without angiographic evidence of vessel obstruction. It occurs in 0.6-3.2% of PCI cases and is associated with increased risk of LV dysfunction, remodeling, arrhythmias, heart failure and cardiac rupture. Diagnosis is typically done using myocardial contrast echocardiography or cardiac MRI. Treatment focuses on improving perfusion and includes vasodilators like adenosine, antithrombotics, mechanical strategies like thrombectomy, and preventing no-reflow through measures like pre-conditioning.
Pressure, Damping and Ventricularization_Crimson Publishers
This document discusses pressure changes that can occur during coronary angiography, specifically damping and ventricularization. Damping is defined as a significant decrease in pressure at the coronary ostium when the catheter is placed, accompanied by the disappearance of pressure waveforms, suggesting no antegrade flow. Ventricularization occurs when blood circulates within a coronary artery like a closed system, deforming the aortic pressure waveform. The document emphasizes the importance of the operator recognizing abnormal pressure changes to avoid complications, and provides solutions like catheter replacement or intracoronary nitroglycerin to address issues.
Coronary Angiography - Views - Dr Hafeesh Fazulu - PIMS.pptx
1) The document discusses various angiographic projections used to visualize the coronary arteries during coronary angiography. It provides 10 possible standard views and describes the optimal views for visualizing different coronary artery segments.
2) Tips are provided on how to learn and remember the different views using props like wires and bottles. Terminologies used in angiography and positioning of the image intensifier are also explained.
3) Chamber views used during left ventriculography are demonstrated in the right anterior oblique and left anterior oblique projections. A demonstration of the views is provided using a 3D anatomy atlas.
Stent thrombosis
Stent thrombosis is a rare but devastating complication occurring in less than 1% of patients within 30 days of stenting and 0.2-6% annually afterwards. It is associated with higher thrombus burden and less procedural success, resulting in higher rates of death, recurrent heart attack, and recurrent stent thrombosis. Risk factors include stent-related issues like early versus late thrombosis, procedure-related issues like incomplete apposition or expansion, vessel-related issues like long lesions or small vessel size, and patient-related issues like diabetes, impaired heart function, renal disease, or non-compliance with dual anti-platelet therapy. Management depends on thrombus burden grade, with direct angioplasty and stenting for small burdens and
OCT in coronary PCI
This document discusses optical coherence tomography (OCT) in coronary artery disease. It provides an overview of OCT, including its history and clinical evidence. It then outlines how to perform an OCT study and presents an algorithmic approach to interpreting OCT images, including assessing plaque morphology, stent sizing and apposition. The document discusses several clinical applications of OCT, such as evaluating acute coronary syndrome, plaque vulnerability, and stent failure. It also reviews limitations and future directions of OCT, including hybrid OCT/IVUS catheters and the use of artificial intelligence.
Coronary lesion assessment
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
No reflow and slow flow phenomenon during pci
This document discusses strategies and prevention of slow flow and no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion through a coronary artery without mechanical obstruction. No-reflow occurs in 8-11% of primary PCIs and is associated with worse clinical outcomes. The pathophysiology involves distal embolization, ischemic injury, reperfusion injury, and individual patient susceptibility. Preventing no-reflow requires reducing thrombus burden, ischemia time, reperfusion injury through anti-inflammatory drugs, and addressing risk factors like diabetes.
Coronary artery dissection
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Coronary angiogram
This document discusses techniques for coronary angiography including cannulating coronary arteries and grafts, angiographic views, and interpreting angiograms. Key points include different techniques for cannulating the left and right coronary arteries as well as grafts like saphenous veins and internal mammary arteries. Common angiographic views are described for visualizing different coronary segments. The document also covers quantitatively and visually assessing coronary narrowings and diagnosing coronary spasm.
Coronary anatomy and angiographic views
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
Chronic total occlusion (CTO)
This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.
PCI procedure complication
This document discusses complications that can occur during percutaneous coronary intervention (PCI) procedures. It notes that while PCI has over a 90% success rate, complications still occur in 1-5% of cases. It identifies several factors that can increase the risk of complications, such as advanced age, urgent procedures, and comorbidities like heart failure or diabetes. The document categorizes types of potential complications and discusses some in more depth, such as vascular access complications, dissections, and perforations. It also examines angiographic and technical factors that can influence complications, as well as indications for emergency cardiac surgery following PCI.
Guiding catheter in coronary intervention
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
coronary imaging
ivus and oct is important cath lab tool for left main PCI. plaque morphology,stent approximation assessment important use of coronary imaging.
Stent Thrombosis
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
IVUS
A brief introduction to the basics of IVUS technology and IVUS interpretation. Ideal for Cardiology Fellows and cardiovascular technologists.
TAVI procedure review with cases
This document provides an overview of trans-catheter aortic valve implantation (TAVI). It discusses the indications for TAVI including symptomatic severe aortic stenosis in high-risk surgical patients. The pre-procedural workup involves imaging to assess anatomy and risk. The procedure involves accessing the femoral or other arteries and deploying a balloon-expandable or self-expanding bioprosthetic valve. Complications include conduction abnormalities, paravalvular regurgitation, and hypotension. Two clinical cases are presented of high-risk patients undergoing TAVI.
Coronary guide wires
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
Chronic total occlusion
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
Guide Extension Catheter
This document discusses guide catheter extensions used in interventional cardiology. It describes four types of guide catheter extensions currently available: Guideliner V2, Guidezilla, Telescope, and Guidion. It provides details on the sizes, lengths, and features of Guideliner V2 and Guidezilla. Applications of guide catheter extensions include increasing backup support, bypassing calcification/tortuosity, limiting contrast use, and facilitating procedures like CTO PCI and thrombus aspiration. Potential complications are discussed, along with tips to minimize risks like dissection or ischemia.
Choice of guiding catheters in PCI
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
FFR(fractional flow reserve)
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
Rotablation - Dr Hafeesh Fazulu - PIMS May 5th 2021
This document discusses rotablation, a technique for treating heavily calcified coronary lesions. It involves using a high-speed rotating burr to cut through calcium deposits. The burr ablates calcium into small particles that are carried away, allowing stent placement. Key points covered include:
- Rotablation differentially cuts calcium while sparing softer tissues
- Orthogonal friction from high-speed rotation allows passing the burr through tortuous segments
- It requires specialized equipment, guidewires, and catheters to position the burr and control its rotation
- Complications can include slow flow, perforation, or getting the burr lodged in the vessel
coronary angiography, LV angiogram and coronary anomalies
Coronary angiography is a procedure that uses dye and x-rays to visualize blood flow through the coronary arteries. It remains the gold standard for detecting significant coronary artery disease. The procedure involves passing a catheter into the heart and injecting contrast dye to see blockages. Coronary angiography is indicated when objective demonstration of the coronary anatomy could help resolve a problem, with competent staff and facilities. It provides information on stenosis levels and collateral circulation. Different views are used to visualize different coronary artery segments. Cannulation techniques depend on arterial origins and graft types.
Final thrombus burden
The document summarizes various strategies for managing thrombus burden during primary angioplasty for myocardial infarction. It discusses thrombus grading scales, the composition and types of thrombus, and the role of medications like GP IIb/IIIa inhibitors (abciximab, tirofiban, eptifibatide), heparin, and bivalirudin. It also compares intracoronary versus intravenous administration of these drugs and evaluates trials comparing different treatment strategies. Mechanical thrombectomy devices and a combined pharmacologic and mechanical approach are also reviewed.
Cath hemodynamics vir
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
CORONARY BALLOONS PRACTICAL ASPECTS.pptx
Coronary balloons, semicompliant, compliant, noncompliant balloons, methods of inflation & deflation,
FRACTIONAL FLOW RESERVE
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
Value of FFR in clinical practice
Fractional flow reserve (FFR) is a technique used to assess the functional severity of coronary artery stenosis. FFR measures the ratio of maximum blood flow in a stenotic artery to normal maximum flow. An FFR of 1 indicates normal blood flow, while an FFR below 0.75 indicates hemodynamically significant stenosis. FFR provides a standardized value that is not dependent on vessel size or myocardial mass. Clinical trials have shown that FFR-guided revascularization improves outcomes compared to angiography-guided procedures alone by avoiding unnecessary stenting. FFR is useful for evaluating intermediate lesions, serial lesions, diffuse disease, ostial lesions, and prior to deciding on revascularization.
More Related Content
What's hot
Coronary artery dissection
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Coronary angiogram
This document discusses techniques for coronary angiography including cannulating coronary arteries and grafts, angiographic views, and interpreting angiograms. Key points include different techniques for cannulating the left and right coronary arteries as well as grafts like saphenous veins and internal mammary arteries. Common angiographic views are described for visualizing different coronary segments. The document also covers quantitatively and visually assessing coronary narrowings and diagnosing coronary spasm.
Coronary anatomy and angiographic views
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
Chronic total occlusion (CTO)
This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.
PCI procedure complication
This document discusses complications that can occur during percutaneous coronary intervention (PCI) procedures. It notes that while PCI has over a 90% success rate, complications still occur in 1-5% of cases. It identifies several factors that can increase the risk of complications, such as advanced age, urgent procedures, and comorbidities like heart failure or diabetes. The document categorizes types of potential complications and discusses some in more depth, such as vascular access complications, dissections, and perforations. It also examines angiographic and technical factors that can influence complications, as well as indications for emergency cardiac surgery following PCI.
Guiding catheter in coronary intervention
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
coronary imaging
ivus and oct is important cath lab tool for left main PCI. plaque morphology,stent approximation assessment important use of coronary imaging.
Stent Thrombosis
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
IVUS
A brief introduction to the basics of IVUS technology and IVUS interpretation. Ideal for Cardiology Fellows and cardiovascular technologists.
TAVI procedure review with cases
This document provides an overview of trans-catheter aortic valve implantation (TAVI). It discusses the indications for TAVI including symptomatic severe aortic stenosis in high-risk surgical patients. The pre-procedural workup involves imaging to assess anatomy and risk. The procedure involves accessing the femoral or other arteries and deploying a balloon-expandable or self-expanding bioprosthetic valve. Complications include conduction abnormalities, paravalvular regurgitation, and hypotension. Two clinical cases are presented of high-risk patients undergoing TAVI.
Coronary guide wires
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
Chronic total occlusion
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
Guide Extension Catheter
This document discusses guide catheter extensions used in interventional cardiology. It describes four types of guide catheter extensions currently available: Guideliner V2, Guidezilla, Telescope, and Guidion. It provides details on the sizes, lengths, and features of Guideliner V2 and Guidezilla. Applications of guide catheter extensions include increasing backup support, bypassing calcification/tortuosity, limiting contrast use, and facilitating procedures like CTO PCI and thrombus aspiration. Potential complications are discussed, along with tips to minimize risks like dissection or ischemia.
Choice of guiding catheters in PCI
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
FFR(fractional flow reserve)
This document discusses fractional flow reserve (FFR), a technique used during coronary catheterization to measure pressure differences across a coronary stenosis and determine if it is causing myocardial ischemia. An FFR value below 0.75 is considered functionally significant while a value above 0.80 rules out ischemia. FFR is useful for evaluating single-vessel disease, left main stenosis, tandem lesions, diffuse disease, grafts, and ostial lesions. Limitations include inability to assess plaque morphology.
Rotablation - Dr Hafeesh Fazulu - PIMS May 5th 2021
This document discusses rotablation, a technique for treating heavily calcified coronary lesions. It involves using a high-speed rotating burr to cut through calcium deposits. The burr ablates calcium into small particles that are carried away, allowing stent placement. Key points covered include:
- Rotablation differentially cuts calcium while sparing softer tissues
- Orthogonal friction from high-speed rotation allows passing the burr through tortuous segments
- It requires specialized equipment, guidewires, and catheters to position the burr and control its rotation
- Complications can include slow flow, perforation, or getting the burr lodged in the vessel
coronary angiography, LV angiogram and coronary anomalies
Coronary angiography is a procedure that uses dye and x-rays to visualize blood flow through the coronary arteries. It remains the gold standard for detecting significant coronary artery disease. The procedure involves passing a catheter into the heart and injecting contrast dye to see blockages. Coronary angiography is indicated when objective demonstration of the coronary anatomy could help resolve a problem, with competent staff and facilities. It provides information on stenosis levels and collateral circulation. Different views are used to visualize different coronary artery segments. Cannulation techniques depend on arterial origins and graft types.
Final thrombus burden
The document summarizes various strategies for managing thrombus burden during primary angioplasty for myocardial infarction. It discusses thrombus grading scales, the composition and types of thrombus, and the role of medications like GP IIb/IIIa inhibitors (abciximab, tirofiban, eptifibatide), heparin, and bivalirudin. It also compares intracoronary versus intravenous administration of these drugs and evaluates trials comparing different treatment strategies. Mechanical thrombectomy devices and a combined pharmacologic and mechanical approach are also reviewed.
Cath hemodynamics vir
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
CORONARY BALLOONS PRACTICAL ASPECTS.pptx
Coronary balloons, semicompliant, compliant, noncompliant balloons, methods of inflation & deflation,
What's hot (20)
Rotablation - Dr Hafeesh Fazulu - PIMS May 5th 2021
Rotablation - Dr Hafeesh Fazulu - PIMS May 5th 2021
coronary angiography, LV angiogram and coronary anomalies
coronary angiography, LV angiogram and coronary anomalies
Viewers also liked
FRACTIONAL FLOW RESERVE
This document discusses fractional flow reserve (FFR), which is a technique used to functionally assess the significance of coronary artery stenosis. FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow if there was no stenosis. It is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia induced by pharmacological agents. An FFR value below 0.75 is associated with inducible ischemia, while a value above 0.80 indicates an insignificant stenosis in most cases. FFR has advantages over angiography alone in evaluating stenosis as it accounts for vessel characteristics like length and takes collateral flow into consideration.
Value of FFR in clinical practice
Fractional flow reserve (FFR) is a technique used to assess the functional severity of coronary artery stenosis. FFR measures the ratio of maximum blood flow in a stenotic artery to normal maximum flow. An FFR of 1 indicates normal blood flow, while an FFR below 0.75 indicates hemodynamically significant stenosis. FFR provides a standardized value that is not dependent on vessel size or myocardial mass. Clinical trials have shown that FFR-guided revascularization improves outcomes compared to angiography-guided procedures alone by avoiding unnecessary stenting. FFR is useful for evaluating intermediate lesions, serial lesions, diffuse disease, ostial lesions, and prior to deciding on revascularization.
Ffr ppt.
1) The document discusses whether fractional flow reserve (FFR) guided interventions should be routine or individualized for patients with multivessel coronary artery disease (MVD).
2) It summarizes the findings of the FAME study which found that an FFR-guided approach reduced major adverse cardiac events compared to an angiography-guided approach alone.
3) The document concludes that while FFR provides useful functional information, an individualized approach is needed considering factors like the number of diseased vessels and whether the study directly compared outcomes to CABG.
02 FFR Johnson aimradial2016 - setup and pitfalls
02 FFR Johnson aimradial2016 - setup and pitfallsInternational Chair on Interventional Cardiology and Transradial Approach
1) FFR measurement requires careful preparation of guidewires, catheters and pressure monitoring equipment as well as standardized hyperemic stimulation, typically with intravenous adenosine. 2) Potential pitfalls include inadequate equalization of pressures, placement of pressure or thermodilution sensors too close to lesions, distortion of pressure readings from excessive wire whip or angulation, and drift over time necessitating re-zeroing of pressures. 3) Pullback tracings can reveal focal or diffuse lesions and hyperemic responses should be assessed both within and outside of lesions.Ffr, raf, shunt calculation, pvr
This document discusses the assessment of intracardiac shunts by cardiac catheterization. It describes how an oximetry run is performed to detect a left-to-right shunt by measuring oxygen saturation at various locations in the heart and great vessels. A significant step-up in oxygen saturation between the right atrium and ventricle or pulmonary artery suggests a left-to-right shunt. The document also discusses calculating shunt ratios using indicator dilution techniques and identifying shunt locations with angiography and pressure measurements. Complications of the procedure are outlined.
IFR - Instantenous wave free ratio
A novel parameter to quantify the hemodynamic severity of coronary artery stenosis without adenosine infusion.
14 FFR Johnson N aimradial2016 - contrast vasodilatory agent
14 FFR Johnson N aimradial2016 - contrast vasodilatory agentInternational Chair on Interventional Cardiology and Transradial Approach
The CONTRAST study evaluated the diagnostic accuracy of contrast FFR (cFFR) compared to resting indices and FFR. It found that cFFR had superior accuracy (85.8%) compared to resting Pd/Pa (78.5%) and iFR (79.9%) for detecting lesions with FFR ≤0.8. cFFR also showed good test-retest repeatability. The study demonstrated that cFFR provides a viable alternative to adenosine for assessing lesion-specific ischemia when FFR is not feasible or contraindicated.07 FFR Kawase Y aimradial2016 - potential of pressure wire use
07 FFR Kawase Y aimradial2016 - potential of pressure wire useInternational Chair on Interventional Cardiology and Transradial Approach
The document discusses the expanded potential uses of pressure wire for complex coronary angioplasty procedures based on experiments and clinical cases from Gifu Heart Center in Japan.
The experiments showed that pressure wires can accurately monitor pressure beneath balloons during angioplasty without significant drift. Clinical cases demonstrated using pressure wires as workhorse wires to facilitate PCI and optimize results by monitoring pressure during the procedures. A minimum contrast procedure was also achieved using a jailed pressure wire.
The advent of new fiber optic pressure wires allows for pressure monitoring during PCI to make procedures more efficient and optimize outcomes similar to the use of IVUS.OCT - few basic facts
1. OCT imaging provides high-resolution cross-sectional images of coronary arteries and stents to assess plaque, guide stent sizing and placement, and confirm procedural success.
2. The OCT catheter is advanced to the region of interest and an automated pullback acquires images as flush media clears blood from the field of view. Images can be used to characterize plaque, measure vessel and stent dimensions, check apposition and expansion, and detect complications.
3. OCT has advantages over IVUS like superior resolution and ability to identify details like thin-cap fibroatheroma, but it also has limitations such as limited tissue penetration and the need for flush media that adds contrast load.
Tilt Table Test
Tilt Table Test presented by Sarfaraz Nawaz and Muhammad Naveed Saeed in King Faisal Specialist Hospital and Reserch Center on November 10, 2016.
Endomyocardial Biopsy
This document discusses endomyocardial biopsy, an invasive procedure used to obtain heart muscle samples for histological examination to diagnose heart muscle disease. It provides a brief history of endomyocardial biopsy, describing early studies in the 1950s-1960s and the development of specialized biopsy catheters. The document outlines the current techniques for endomyocardial biopsy via the femoral, jugular, and subclavian veins. Potential complications are noted to be 3% for access site issues, 3% for biopsy related, and 1% each for arrhythmias and conduction abnormalities.
OCT Presentation with St. Jude. Medical System.
The Optis system uses optical coherence tomography (OCT) to provide high-resolution cross-sectional images of coronary arteries. It consists of an ILUMIEN console, PressureWire and Aeris wireless FFR technologies, and a Dragonfly Duo catheter. The catheter contains an optical fiber that rapidly acquires images during a pullback at frame rates up to 180 fps. OCT can detect features not visible on angiography like thrombus, plaque rupture, and stent apposition. The procedure involves purging the catheter, positioning it in the artery, and acquiring pullback images during contrast injection to assess the vessel and guide clinical decision making.
16 FFR Curzen N aimradial2016 - FFR-CT future
16 FFR Curzen N aimradial2016 - FFR-CT futureInternational Chair on Interventional Cardiology and Transradial Approach
1) A study evaluated the impact of incorporating FFRCT data with CT angiogram results compared to CT angiogram alone in 200 patients.
2) The addition of FFRCT data led to a change in management in 36% of cases, similar to prior studies using invasive FFR.
3) This suggests non-invasive FFRCT can mimic invasive FFR's ability to refine management decisions made based on angiography alone. A definitive randomized trial is now needed to establish FFRCT's role as a default screening test for patients with chest pain.18 FFR Ruzsa Z aimradial2016 - peripheral disease
18 FFR Ruzsa Z aimradial2016 - peripheral diseaseInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes potential applications of pressure wire measurement in the peripheral circulation and presents results from a study examining its use in below-the-knee (BTK) angioplasty. The study aimed to assess correlations between invasive and non-invasive measurements of blood pressure and flow pre-and post-BTK intervention. 31 patients with critical limb ischemia underwent angiography, pressure wire assessment of resting and hyperemic pressures, and measurements of ankle-brachial index and tissue oxygen levels. Procedural success was achieved in all patients based on angiographic and clinical improvement. Correlations were observed between invasive pressure and non-invasive flow measurements, though further studies are needed to validate results and clarify optimal vasodilPCI vs. thrombolysis
This document discusses primary percutaneous coronary intervention (PCI) versus thrombolysis for treating ST-elevation myocardial infarction (STEMI). It notes that PCI is more effective at reopening blocked arteries, reduces recurrent ischemia and shorter hospital stays compared to thrombolysis, but requires an invasive procedure and experienced staff. Thrombolysis can be used in facilities without PCI capabilities if administered within 30 minutes of arrival, but has higher risks of bleeding complications. The document recommends PCI over thrombolysis when experienced staff can perform it within 90-120 minutes of arrival, or if thrombolysis is contraindicated or failed to reopen the artery.
IVUS Image Interpretation and Analysis
IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images.
There are 3 situations in which IVUS has the most clinical utility:
Small vessel stenting: Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA1.
In-Stent restenosis: In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area.
Difficult to assess lesions: At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign.
Thrombolysis
This document discusses thrombolysis, which is a treatment that dissolves dangerous blood clots in the body's blood vessels. Thrombolysis can be used to treat conditions like deep vein thrombosis, pulmonary embolism, stroke, heart attack, and mesenteric ischemia by improving blood flow and preventing damage. Blood clots form when blood vessels become damaged or when there is excessive clotting within the blood. Some common causes of blood clots include injury, inherited clotting disorders, and lack of movement. Thrombolytics like streptokinase, urokinase, and tissue plasminogen activators are administered to break up clots. Diagnostic tests include ultrasounds, venography
Thrombolysis vs PCI for STEMI
1) Primary PCI is the recommended reperfusion method when it can be performed in a timely manner by experienced operators, while fibrinolytic therapy is recommended when the anticipated PCI time exceeds 120 minutes.
2) When fibrinolytic therapy is indicated, it should be administered within 30 minutes of hospital arrival.
3) In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI symptoms within the previous 12 hours when primary PCI cannot be performed within 120 minutes of first medical contact.
Mechanical Thrombectomy
Mechanical thrombectomy devices show some advantages for treating deep vein thrombosis (DVT) but have limitations as standalone therapies. When used in combination with thrombolytics, mechanical thrombectomy can speed lysis, potentially reduce lytic doses and treatment time, and allow treatment of patients who cannot receive thrombolytics. However, data on their long-term safety and efficacy compared to thrombolysis alone is still limited. Standalone mechanical thrombectomy often provides only partial clot removal for DVT.
Thrombus aspiration in ppci
Manual thrombus aspiration during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) was not associated with reduced long-term mortality according to a study of 10,929 patients. While thrombus aspiration was linked to higher procedural success rates and lower in-hospital complications, long-term survival was similar between patients who received thrombus aspiration and those who underwent PPCI only. After adjusting for differences in patient characteristics and procedures using propensity score matching, thrombus aspiration during PPCI was still not found to reduce mortality risk.
Viewers also liked (20)
14 FFR Johnson N aimradial2016 - contrast vasodilatory agent
14 FFR Johnson N aimradial2016 - contrast vasodilatory agent
07 FFR Kawase Y aimradial2016 - potential of pressure wire use
07 FFR Kawase Y aimradial2016 - potential of pressure wire use
Similar to FFR with St. Jude System
What is Carotid Angioplasty
Cardiology is an element of internal medicine. A classification of medicine ranging from congenital defects to acquired heart diseases such as coronary artery disease & congestive heart failure,Carotid angioplasty is basically a surgical procedure which is designed to open clogged arteries so as to treat or prevent strokes. Carotid arteries are located on either sides of the neck & are the main arteries which supply blood to the brain.
For more info visit: goo.gl/j3MCEH
Diagnostic procedure of dsa and management of its
This document provides information on diagnostic cerebral angiography procedures and managing complications. It begins with a brief history and overview, then discusses indications, materials, and steps for the procedure. Potential neurological complications discussed include ischemic stroke, transient global amnesia, cortical blindness, and aneurysm rupture. Risk factors and treatments for complications are outlined. Non-neurological complications like hematoma, pseudoaneurysm, and contrast-induced nephropathy are also summarized. The document provides detailed information on performing angiography safely and managing various potential issues.
Lecture 3
CT angiography of the cerebral arteries is a noninvasive technique that uses CT imaging and contrast injection to visualize the arteries of the head and neck. It can detect abnormalities such as aneurysms and atherosclerosis. The procedure involves injecting iodinated contrast into a vein while obtaining a CT scan from the neck up. The timing of the scan is calculated using a test bolus to image the arteries during the peak contrast enhancement phase. Post-processing techniques like 3D rendering and curved reformats are used to interpret the images.
Coronary ct angiography
This document discusses the evolution and advances in coronary CT angiography (CCTA) technology and its role in the assessment of coronary artery disease (CAD). Key points include:
- CCTA has advanced from early CT scanners with 4-minute scan times to modern multi-detector scanners that can image the entire heart in a single heartbeat.
- CCTA provides information on coronary artery anatomy, plaque characteristics, and has prognostic value when assessing coronary artery calcium scoring.
- CCTA has good accuracy for detecting CAD compared to invasive coronary angiography, especially for ruling out disease, though its role in asymptomatic patients is still unclear.
- CCTA is useful for evaluating coronary anomalies, bypass grafts,
Coronary aneurysm: At a glance and Management.pptx
This document discusses coronary artery aneurysms (CAAs). It defines a CAA as a dilatation of the coronary artery exceeding 50% of the reference vessel diameter. CAAs can be classified based on their morphology, vessel wall composition, and the vessels affected. Common risk factors include atherosclerosis, vasculitis, and intracoronary manipulation. CAAs are often asymptomatic but can occasionally cause symptoms. Diagnosis is typically via coronary angiography. Management involves medical therapy, percutaneous interventions such as stenting, or surgery, with challenges that include proper sizing and coverage of aneurysmal segments.
Carotid stenosis
This document discusses carotid artery stenosis, which can cause transient ischemic attacks (TIAs) or stroke. It presents 5 case studies of patients who presented with symptoms related to carotid stenosis. The key points are that carotid stenting can effectively treat symptomatic stenosis and reduce the risk of future strokes. However, stenting is not recommended for complete carotid occlusions seen on angiography. Medical management of associated conditions like diabetes and hypertension is also important. The timing of stenting depends on whether the patient presents with TIA versus an acute stroke.
Hersenperfusie en het theorema van Bayes - Dr. P. Seynaeve
1) Several methods can quantify cerebral blood flow, mean transit time, and arterial delay from perfusion CT scans, including deconvolution methods and Bayesian methods.
2) Permeability surface is significantly higher in acute ischemic stroke patients and can predict hemorrhagic transformation, with higher permeability seen in those receiving tPA treatment.
3) Collateral flow deficit measured on perfusion imaging correlates with recanalization success after thrombolysis or thrombectomy, with better collaterals associated with higher recanalization rates.
Cardiac ct
Cardiac CT uses X-rays and computer technology to image the heart and coronary arteries. It can detect calcium buildup in arteries, assess coronary arteries via angiography, and evaluate heart function. The test involves injecting contrast dye and potentially heart rate control drugs. Images are taken rapidly during breath-holds to freeze heart motion. Cardiac CT can diagnose heart disease by identifying plaque and blockages without the risks of angiography.
Combined carotid and coronary disease the strategy should be
1. Combined carotid and coronary artery disease presents challenges in determining the optimal treatment strategy. Performing carotid endarterectomy and coronary artery bypass grafting simultaneously or in stages both carry risks.
2. Factors such as the severity of stenosis in the carotid and coronary arteries, and a patient's surgical risk profile must be considered. High grade stenosis in both territories typically warrants staged procedures to avoid complications.
3. Preventing embolic sources, maintaining adequate cerebral perfusion and temperature, and using monitoring techniques can help reduce risks of central nervous system injuries during combined or staged carotid and cardiac surgeries. Close evaluation of individual patient characteristics is important for surgical planning.
Intracranial atherosclerotic disease
1) Intracranial atherosclerotic disease (ICAD) is a common cause of stroke. While medical treatments like antithrombotics and statins are recommended, endovascular interventions may be considered for recurrent strokes.
2) Early studies of angioplasty and stenting for ICAD showed high complication rates. The SAMMPRIS trial found stenting plus medical therapy was worse than medical therapy alone. Subsequent studies using strict criteria saw lower complication rates.
3) Current recommendations are for medical management as first-line for ICAD. Endovascular treatments like submaximal angioplasty may be considered for recurrent strokes despite medical therapy, based on the underlying stroke mechanism
Cardiac CT.pptx
Cardiac CT and MRI can be used to evaluate the heart and coronary arteries. Cardiac CT uses calcium scoring to detect calcifications and assess risk of heart events. Coronary CT angiography uses contrast injection and ECG-gating to obtain images of the coronary arteries and detect stenoses. Retrospective and prospective ECG-gating techniques are used to optimize image quality while reducing radiation dose. Cardiac MRI provides better soft tissue definition than CT but poorer coronary artery imaging. It uses dark blood spin echo sequences and white blood gradient echo sequences to obtain anatomical and functional images of the heart without radiation.
Ec ic bypass
1. The history of cerebral revascularization began in 1942 with various techniques being developed through the 1970s including EDAMS, CCA-ICA bypass, and STA-MCA bypass.
2. Revascularization can be direct, using vessel to vessel anastomoses, or indirect, promoting new capillary formation. Direct techniques provide immediate flow but require a recipient vessel over 1mm, while indirect revascularization relies on collateral formation.
3. Common indications for revascularization include moyamoya disease, complex aneurysms, skull base tumors, and cerebral ischemia. However, recent studies found no benefit for revascularization over medical management for treating ischemia.
4. stroke- investigations and management
The document summarizes the investigations and management of stroke. Key points include:
1. Imaging such as CT or MRI is used to distinguish between hemorrhagic and ischemic stroke and identify underlying causes. CT is more widely available while MRI is more sensitive.
2. Risk factors, cardiac investigations, and vascular imaging are also conducted to determine the cause of ischemic stroke.
3. Management of ischemic stroke involves supportive care, thrombolysis within 3 hours, aspirin to prevent recurrence, and carotid surgery for severe stenosis to reduce risk of further stroke.
4. For hemorrhagic stroke, reversal of coagulopathy and surgical evacuation may be considered to control bleeding and intracranial pressure
Noreflow
This document discusses no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion without angiographic evidence of mechanical vessel obstruction. The incidence of no-reflow is 0.6-2% for all PCI, up to 11.5% for primary PCI, and up to 40% for SVG PCI or rotational atherectomy. Preventing no-reflow is better than treating it. Methods discussed to prevent or treat no-reflow include thrombus aspiration, direct stenting, deferred stenting, distal protection devices, and pharmacological management with intracoronary alteplase. One study aims to determine if low doses of intracoronary altepl
Coronary angioplasty (1)
The document discusses coronary angioplasty, a minimally invasive procedure to open blocked coronary arteries. It involves inserting a catheter into the heart and inflating a small balloon to widen narrowed arteries. A stent may also be inserted to keep the artery open. The document outlines the indications, contraindications, procedure steps, risks, postoperative care and complications of coronary angioplasty and stent placement.
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad ateroscleróticaSociedad Española de Cardiología
Focus en el diagnóstico y tratamiento de las enfermedades coronarias. Evolución no invasiva de la enfermedad ateroscleróticaOphthalmodynamometry.
Ophthalmodynamometry is a clinical procedure that measures the pressure in the ophthalmic artery to assess patency of the internal carotid artery. It involves applying pressure to the eye until the central retinal artery collapses, noting the diastolic and systolic pressures. This provides information about blood flow through the ophthalmic artery and can detect carotid artery occlusive diseases, helping prevent strokes. The procedure has been used since the early 1900s and modern methods include compression or suction ophthalmodynamometry. Precautions must be taken and it can detect conditions affecting the carotid or cerebral vasculature.
Cerebral angiography - medical information
Cerebral angiography is an X-ray examination method with the help of which the state of blood vessels, their functional abilities, roundabout blood circulation, the presence of deviations and the size of pathological zones are determined. i hope this will be useful among the medical professionals.
please comment
thank u
Advances in Imaging of ischaAemic stroke
This document summarizes advances in imaging for ischemic stroke. It discusses the role of CT angiography (CTA) in detecting vessel occlusion and infarct core. Several major clinical trials demonstrated the benefits of endovascular therapy for certain patients. Guidelines now recommend endovascular treatment for those meeting specific criteria within 6 hours of onset. CT perfusion can identify penumbra and guide patient selection. While MRI is most accurate for core imaging, the time required may delay treatment. Faster door-to-treatment times are important to improve outcomes. Advanced imaging like CTA helps identify patients most likely to benefit from endovascular intervention.
Role of CT Scan Calcium scoring in Coronary Artery Disease
CT Scan calcium scoring study is a non- invasive way of obtaining information about
presence,
location and
extent of calcified plaque in the coronary arteries.
Because calcium is a marker of CAD, the amount of calcium detected on a cardiac CT scan is helpful prognostic tool.
The findings on cardiac CT are expressed as a calcium score.
Similar to FFR with St. Jude System (20)
Coronary aneurysm: At a glance and Management.pptx
Coronary aneurysm: At a glance and Management.pptx
Hersenperfusie en het theorema van Bayes - Dr. P. Seynaeve
Hersenperfusie en het theorema van Bayes - Dr. P. Seynaeve
Combined carotid and coronary disease the strategy should be
Combined carotid and coronary disease the strategy should be
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Role of CT Scan Calcium scoring in Coronary Artery Disease
Role of CT Scan Calcium scoring in Coronary Artery Disease
Recently uploaded
Under Pressure : Kenneth Kruk's Strategy
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
Hypertension and it's role of physiotherapy in it.
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
PrudentRx: A Resource for Patient Education and Engagement
PrudentRx enhances healthcare by educating patients and ensuring effective medication management in a complex, evolving landscape.
Champions of Health Spotlight On Leaders Shaping Germany's Healthcare.pdf
This edition features a handful of Champions of Health: Spotlight On Leaders Shaping Germany's Healthcare that are leading us into a better future.
Luxurious Spa In Ajman Chandrima Massage Center
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
Visit : https://massagespaajman.com/
Call : 052 987 1315
PrudentRx's Function in the Management of Chronic Illnesses
PrudentRx ensures effective, cost-efficient medication management for chronic diseases, enhancing patient health and productivity.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac Care
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.LEAD Innovation Launch_WHO Innovation Initiative.pptx
WHO Innovation Initiative. WHO Innovation Initiative. WHO Innovation Initiative. WHO Innovation Initiative.
Tips for Pet Care in winters How to take care of pets.
Tips for Pet Care in winters How to take care of pets.
CANSA support - Caring for Cancer Patients' Caregivers
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
Letter to MREC - application to conduct study
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.CCSN_June_06 2024_jones. Cancer Rehabpptx
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Recently uploaded (20)
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Michigan HealthTech Market Map 2024 with Policy Makers, Academic Innovation C...
Hypertension and it's role of physiotherapy in it.
Hypertension and it's role of physiotherapy in it.
PrudentRx: A Resource for Patient Education and Engagement
PrudentRx: A Resource for Patient Education and Engagement
Champions of Health Spotlight On Leaders Shaping Germany's Healthcare.pdf
Champions of Health Spotlight On Leaders Shaping Germany's Healthcare.pdf
PrudentRx's Function in the Management of Chronic Illnesses
PrudentRx's Function in the Management of Chronic Illnesses
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac Care
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac Care
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
LEAD Innovation Launch_WHO Innovation Initiative.pptx
LEAD Innovation Launch_WHO Innovation Initiative.pptx
Tips for Pet Care in winters How to take care of pets.
Tips for Pet Care in winters How to take care of pets.
CANSA support - Caring for Cancer Patients' Caregivers
CANSA support - Caring for Cancer Patients' Caregivers
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...
FFR with St. Jude System
- 1. ……………....... Muhammad Naveed Saeed Cath Lab Tech. January 7, 2016
- 3. Technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis (narrowing, usually due to atherosclerosis) to determine the likelihood that the stenosis impedes myocardial ischemia.
- 6. FFR assess of lesion severity. FFR invasive test and allows real-time estimation of the effects of a narrowed vessel. No plaque morphology information. physical exercise or some intravenous medication is to increase the workload and oxygen demand of the heart muscle, and ischemia is detected using ECG changes or Nuclear imaging.
- 7. • Adenosine: 6mg/500cc NS (12mcg/cc) • IC boluses: ○ –60 mcg (5 cc) ○ –96 mcg (8 cc) ○ –120 mcg (10 cc) • IV drip 140 mcg/Kg/Min
- 8. • http://www.cathlabdigest.com/article/return-ic-adenosine-ffr-history-dose- technique Issue number: volume 23 - issue 12 - December 2015
- 9. Significant <0.80 Grey Scale 0.8 Non Significant > 0.8
- 10. FFR with ILUMIEN St. Jude. Medical
Editor's Notes
- The ratio of distal coronary pressure to aortic pressure during maximal hyperemia is called the fractional flow reserve (FFR) and is a pressure-derived estimate of the percent of normal coronary blood flow that would be available to the myocardium. A normal value is 1, while values <0.80 are associated with provocable ischemia.
- Fractional flow reserve is defined as the pressure behind (distal to) a stenosis relative to the pressure before the stenosis. The result is an absolute number; an FFR of 0.50 means that a given stenosis causes a 50% drop in blood pressure. In other words, FFR expresses the maximal flow down a vessel in the presence of a stenosis compared to the maximal flow in the hypothetical absence of the stenosis.
- For the FFR a 0.014" sensor-tipped guidewires have been used safely and flow measurements distal to a stenosis. These can measure both pressures proximal, distal and flow velocity For the pressure-sensor guidewires, translesional pressure measured at maximum hyperemia is measured; hyperemia is induced by intravenous (140 mcg/kg/min) or intracoronary adenosine (30 to 60 mcg bolus).
- The efficacy of FFR has been proven over many clinical trials such as FAME and FAME II.
- Adenosie Papaverine NTP Regadenosin
- Adenosine Papaverine NTP Regadenosin
- Enter patient demographic. And click on start new FFR recording., Manufacture April 2014
- Turn on machine by power button which located just right upper side of the keyboard.
- For entering new patient just click on Add new patient, tab located mid upper right.
- Entering patient demographic.
- This is called WI Box
- Connect direct one RJ
- For Sensis Select Hemo P3 only in Lab 2 And Hemo P3 FFR in Lab 4
- The new pressure wire “ Aeris “ features a specially developed hydrophilic coating that lower friction between guide wire and guide catheter as well as guide wire and device delivery system than other pressure wires.
- Remove the pouch from the box. Remove pressure wire. Place the tray flat on table. Follow printed instruction on the tray to prepare pressure wire for use.
- Fill Coil with Saline; take care not to expose pressure wire transmitter to fluids. Make sure to pull torque device forward along the wire; do not bend it loose.
- Carefully tear open the flaps holding pressure wire transmitter to the tray. Lift pressure wire transmitter up and place it on the bed next to the tray without removing the wire from coil. Make sure pressure wire is fully inserted into pressure wire transmitter.