Gilchrist IC - AIMRADIAL 2013 - Legal aspects
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This document appears to be from a presentation on medical legal issues related to radial access. It discusses a case where a 34-year-old woman died from a coronary artery dissection during a routine cardiac catheterization performed through femoral access. It also mentions common features of medical malpractice suits, such as when an unexpected event occurs, and issues that can arise when risk, benefits and skill sets are unclear, such as for radial learners and legacy femoral operators.
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2. Timely treatment is critical, as each minute of delay results in loss of brain cells and function. The training aims to optimize teamwork and processes to minimize time to treatment.
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This document summarizes a presentation given by Dr. Olivier Bertrand on post-PCI FFR measurement. It discusses studies showing that a post-PCI FFR of 0.90 or higher is associated with lower rates of re-PCI and major adverse cardiac events. It then outlines the proposed PREDICT randomized study to evaluate whether routine post-PCI FFR measurement can guide PCI strategy and completion. The study would measure FFR after successful PCI in all-comers and randomize patients to clinical follow-up alone or with guidance from the post-PCI FFR results. The goal is to establish if physiology-guided PCI optimization can improve outcomes and reduce costs.PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...
PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...International Chair on Interventional Cardiology and Transradial Approach
This document summarizes lessons learned from the DEFINE-FLAIR and iFR-SWEDEHEART clinical trials. The trials found:
1) Decision-making based on instantaneous wave-free ratio (iFR) was non-inferior to fractional flow reserve (FFR) for guiding revascularization and reducing major adverse cardiac events over 1-2 years.
2) iFR-guided decisions resulted in significantly less revascularization procedures compared to FFR.
3) Subgroup analysis found increased event rates among diabetic patients evaluated with FFR compared to iFR.
4) iFR has been upgraded to a Class IA recommendation in European Society of Cardiology guidelines based on these trialsPCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry
PCI & AimRadial 2018 | Use of physiology in ACS - Colin Berry International Chair on Interventional Cardiology and Transradial Approach
1. The document discusses the use of physiology in acute coronary syndrome (ACS) patients, including trials evaluating fractional flow reserve (FFR) and index myocardial resistance (IMR) measurements.
2. Several trials showed that FFR-guided revascularization in multivessel disease STEMI patients reduced major cardiac events compared to culprit-only PCI or medical therapy. Ongoing trials are further evaluating FFR in ACS.
3. IMR predicts mortality and heart failure in STEMI patients and adversely remodeling post-STEMI.
4. Incomplete revascularization is common in ACS and associated with worse outcomes; FFR may help guide more complete revascularization. The clinical utility of physiology in ACSPCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...
PCI & AimRadial 2018 | FFR using 4Fr catheters: Can Slender Technique Work He...International Chair on Interventional Cardiology and Transradial Approach
This document discusses the potential use of 4 French (4F) catheters for fractional flow reserve (FFR) measurements as a less invasive alternative to larger catheters. It notes that 4F catheters have a smaller profile but can lack the ability to directly perform percutaneous coronary intervention if needed. The document outlines key considerations for using 4F catheters, including ensuring the catheter lumen is well flushed and the pressure transducer is not damped. It concludes that improvements are still needed, such as reducing friction between the pressure wire and catheter, in order to maximize the benefits of using the smallest catheter size possible.PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. FearonInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses using fractional flow reserve (FFR) to evaluate ambiguous left main coronary artery disease. It presents a case of an 82-year-old woman with chest pain and a recent stent in the circumflex artery. FFR measurements of the left main and left anterior descending artery were 0.64, indicating significance. Intravascular ultrasound also suggested significance. The left main and proximal left anterior descending artery were stented, and post-procedure FFR measurements improved. The document reviews evidence that FFR can safely guide decisions about revascularization of ambiguous left main lesions.PCI & AimRadial 2018 | FFR-CT - Colin Berry
PCI & AimRadial 2018 | FFR-CT - Colin BerryInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a presentation on CT-derived fractional flow reserve (FFR-CT). It discusses how FFR-CT increases the positive predictive value of coronary CT angiography (CTCA). Several landmark studies are summarized that evaluated the diagnostic accuracy of FFR-CT compared to CTCA. The PACIFIC trial findings showing high diagnostic accuracy of FFR-CT are described. Ongoing and upcoming clinical trials using FFR-CT like PRECISION and DECISION are mentioned. Novel applications of FFR-CT for biomechanics analysis and PCI planning are presented. Finally, new methods like user-generated CT-FFR that may reduce processing time are introduced, though accuracy needs further evaluation.PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...
PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...International Chair on Interventional Cardiology and Transradial Approach
This document summarizes the results of a study evaluating the diagnostic accuracy of quantitative flow ratio (QFR) compared to fractional flow reserve (FFR) as the reference standard. The study included 317 lesions in 273 patients. Key results included:
- QFR showed superior sensitivity and specificity for detecting functionally significant lesions compared to 2D quantitative coronary angiography.
- QFR values correlated well with invasive FFR measurements.
- QFR could be computed within a similar time frame as FFR measurements.
- A hybrid approach using QFR and FFR may allow pressure wire-free assessment in 68% of lesions while maintaining high diagnostic accuracy.More from International Chair on Interventional Cardiology and Transradial Approach (20)
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PCI & AimRadial 2018 | Radial Artery Puncture - Ian C Gilchrist
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