This document outlines the key points of a presentation on guide catheter selection for radial PCI. It discusses the causes of transradial PCI failure, characteristics of an ideal guide catheter, factors for choosing the right size and type of guide, and provides examples of guide catheters for different coronary arteries. The presentation emphasizes choosing a guide catheter that provides stable, coaxial engagement and sufficient backup support for completing complex PCI procedures through the radial artery.
Safety and efficacy of using a single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST-elevation myocardial infarction (RAPID)
Safety and efficacy of using a single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST-elevation myocardial infarction (RAPID)
Initial experience with the Glidesheath Slender for transradial coronary angiography and intervention: a feasibility study with prospective radial ultrasound follow-up
Initial experience with the Glidesheath Slender for transradial coronary angiography and intervention: a feasibility study with prospective radial ultrasound follow-up
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
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Nicolas Boudou, France
The Experts “Live” Workshop 2017
Saturday, September 16th, 2017
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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ASA GUIDELINE
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Kaul P - AIMRADIAL 2014 Technical - Guide catheter
1. 3rd
Advanced
Interna>onal
Masterclass
AimRADIAL2014
Chicago,
IL
October
23-‐25
GUIDE
CATHETER
SELECTION
FOR
RADIAL
PCI
Thursday
October
23,
2014,
2:25
to
2:40
pm
Prashant
Kaul,
MD,
FACC,
FSCAI
Assistant
Professor
of
Medicine
University
of
North
Carolina,
Chapel
Hill
Medical
Director,
Chest
Pain
Center
Associate
Director,
Interven>onal
Cardiology
Training
Program
3. Outline
1. What
are
the
causes
of
Trans
radial
PCI
Failure?
2. The
ideal
guide
catheter
3. Choosing
the
right
size
4. Choosing
the
right
guide
5. Cases
examples
4. Outline
1. What
are
the
causes
of
Trans
radial
PCI
Failure?
2. The
ideal
guide
catheter
3. Choosing
the
right
size
4. Choosing
the
right
guide
5. Cases
examples
5. Mechanisms
and
Causes
of
Transradial
PCI
Failure
98
out
of
2100
Transradial
PCI
procedures
Failure
of
Arterial
Access
Failure
to
Advance
Guide
Failure
to
Complete
PCI
due
to
lack
of
Guide
Support
13%
51%
35%
Inadequate
arterial
puncture
(13%)
Radial
artery
spasm
(34%)
Subclavian
tortuosity
(18%)
Radial
artery
dissec>on
(10%)
Inadequate
backup
support
(17%)
Radial
loop/tortuosity
(6%)
Radial
artery
stenosis
(1%)
Dehghani
P
et
al.
J
Am
Coll
Cardiol
Intv
2009;
2:
1057–64
6. Guide
Catheter
SelecKon:
General
Points
I
The
Ideal
Guide
Catheter
1. Safe,
sob
>p
with
low
risk
of
os>al
dissec>on
2. Easy
to
engage
os>um
3. Coaxial
engagement
4. Good
backup
support
5. Stable
7. Guide
Catheter
SelecKon:
General
Points
II
• Leb
vs.
Right
radial
approach
• Guide
Catheter
choices
(size/shape)
• Pick
the
“right”
guide/approach
for
you
• Get
comfortable
with
it
8. Guide
Catheter
SelecKon:
General
Points
III
• Passive
support:
larger,
s>ffer
guide
– Relies
on
shab
and
>p
shape
to
os>al
engagement
• Ac>ve
Support:
deep
intuba>on
– Uses
contralateral
aor>c
root
to
maintain
support
• Guide
Extension
(Mother-‐Child
system)
– GuideLiner
(Vascular
Solu>ons,
Inc)
– Guidezilla
(Boston
Scien>fic)
• Other
techniques
– Balloon
Anchoring
– Buddy
Wire
9. Femoral
vs
Right
RA
vs
LeN
RA
Patel
T,
Shah
S,
Pancholy
S.
Patel’s
Atlas
of
Transradial
Interven>on:
The
Basics
and
Beyond
2012.
FEMORAL
RIGHT
LEFT
At
least
2
points
of
Resistance
10.
11. Outline
1. What
are
the
causes
of
Trans
radial
PCI
Failure?
2. The
ideal
guide
catheter
3. Choosing
the
right
size
4. Choosing
the
right
guide
5. Cases
examples
12. RelaKve
Size
5
Fr
2.3
mm
6
Fr
Mean
Radial
Artery
7
Fr
2.5
mm
Inner
Diameter
2.9
mm
ID 8F sheath
OD 8F guide
2.6
mm
±
0.41
mm
1.7
mm
2.0
mm
2.34
mm
2.31
mm
Sheath
Guide
Men:
2.69
±
0.40
mm
Women:
2.43
±
0.38
mm
1.67
mm
1.98
mm
Adapted
from
From
AM,
Gula>
R,
Prasad
A,
Rihal
CS.
CCI
2010.
76:
911-‐916.
13. The
Role
of
Larger
(≥
7
Fr)
Guides
• More
support,
ID
for
complex
lesions,
larger
devices:
– Chronic
Total
Occlusions
– Bifurca>on,
kissing
balloon,
2
stent
techniques
– Rota>onal
Atherectomy
with
burr
≥
1.75
mm
– JoStent
Grabmaster
Rx
≥
4.5
mm
14. Backup
Support
of
Regular
Guiding
Catheters
pushing force of the gauge
resistance encountered by a
advancement into a blood
support of the guiding
pushing force of the gauge
catheter disengaged from
small arrow). All meas-urements
measured for the 4-in-5,
systems as well as for the
systems by using the same
child catheter (ST01)
tree model by 0, 1, 5,
arrow) out of the mother
stent delivery system
tree model at a constant
gauge machine (Fig. 1D,
backup support of the
defined as the pushing
mother guiding cathe-ter
ostium (Fig. 1D, small
repeated five times.
Takeshita
S
et
al.
CCI 2012. 80:292–297.
Fig. 2. Backup support of the regular guiding catheters
The backup support of the 5- and 6-Fr guiding catheters was
15. Larger
Transradial
OpKons
7Fr
Sheath
• Oversized
• Spasm
• Occlusion
Thin
walled
Sheath
• Glidesheath
Slender
• Significant
advance
Sheathless
• Dedicated
systems
• Home
made
systems
✗
16. Glidesheath
Slender
Initial Experience with the Glidesheath Slender 3
Initial Experience with the Glidesheath Slender 3
Initial Experience Initial Experience with the with Glidesheath the Glidesheath Aminian
A,
et
al.
CCI
2013.
Oct 6. doi: 10.1002/ccd.25232.
17. Sheathless
Concept
7
Fr
2.9
mm
2.34
mm
2.31
mm
Sheath
Guide
Mean
Radial
Artery
Inner
Diameter
2.6
mm
±
0.41
mm
Men:
2.69
±
0.40
mm
Women:
2.43
±
0.38
mm
Adapted
from
From
AM,
Gula>
R,
Prasad
A,
Rihal
CS.
CCI
2010.
76:
911-‐916.
5
Fr
2.3
mm
OD
7F
guide
<
Average
RAD
18. Commercial
Sheathless
Guide
System
Courtesy
Rajiv
Gula>
• ID
of
7.5
Fr
guide
• OD
of
6
Fr
sheath
• Tapered
dilator
• Hydrophilic
coated
• Smooth
inser>on,
liqle
spasm
• Tendency
to
slip
• Expensive
Sheathless Eaucath, Asahi Intecc®, Japan
19. Tapering
a
Standard
Guide
Catheter
for
Sheathless
InserKon
into
the
Radial
Artery
gauge
Men-drel
Intro-ducer
6F GC
Fr
then
200
bolus
pseudo-taper’’
5
912 Variable, Age (yrs) Male gender Diabetes Hypertension Hypercholesterolemia Body mass index Chest pain prior to Preprocedural shock Peripheral vascular Cerebrovascular disease Prior CABG Fig. 1. A 5-Fr diagnostic catheter inserted into and through a
Prior myocardial 7-Fr guiding catheter and over a 0.035 inch standard J-tip
Single vessel disease wire for easier percutaneous insertion of the guiding catheter
Angiographic presence into the radial artery. [Color figure can be viewed in the online
Most severe lesion issue, which is available at wileyonlinelibrary.com.]
B2 C Stents per patient Drug eluting stent Glycoprotein IIb/Select
Cook
Diagnostic Guidewire (Cordis Corporation, Miami,
FL) (2) insertion of a long (125 cm) 5 Fr multipurpose
InfinitiVR Diagnostic Catheter (Cordis Corporation, Miami,
FL) into and through a 6 Fr guiding catheter over a 0.035
5F 125 cm
MPA2
0.035”
J
Wire
• Lack
of
hydrophilic
coa>ng
• Available
in
US,
inexpensive
• Imperfect
transi>on
of
dilator
• “Catch”
on
inser>on
From
AM,
Gula>
R,
Prasad
A,
Rihal
CS.
CCI
2010.
76:
911-‐916.
interventions using a sheathless technique with stand-ard
large bore nonhydrophilic guiding catheters.
TABLE I. Baseline Characteristics
From et al.
8
Fr
guide
6
Fr
125
cm
MPA2
diagnos>c
0.035”
J
Wire
20. Going
Smaller:
5Fr
Guides
PROS
• Allows
PCI
through
5Fr
Sheath
• Stent
up
to
4.5
mm,
IVUS,
Rotablator
1.25
mm
• Improved
success
with
small
radials
and
difficult
loops
• Less
trauma>c
during
deep
intuba>on
CONS:
• Higher
risk
of
air
trapping/embolism
during
catheter
removal
• Less
op>mal
coronary
visualiza>on
• Complex
interven>ons
and
bulky
devices
not
feasible
• Kissing
balloon
not
possible
22. Outline
1. What
are
the
causes
of
Trans
radial
PCI
Failure?
2. The
ideal
guide
catheter
3. Choosing
the
right
size
4. Choosing
the
right
guide
5. Cases
examples
23. LAD
OpKons
Table 4. PCI-Guiding Catheters
All U.S. Canada-Europe China India Japan
LAD
Judkins left 22.5 6.3 21.6 20.7 10.0 38.4
XB 3.0 8.1 10.1 7.0 20.7 16.7 0.0
XB 3.5 18.2 26.6 18.9 13.8 6.7 5.8
Amplatz left 1.4 2.5 1.3 0.0 3.3 0.0
Tiger II 0.6 1.3 0.5 0.0 3.3 0.0
EBU 3.5 27.9 35.4 26.9 41.4 50.0 20.9
EBU 3.75 6.5 7.6 7.9 3.4 3.3 5.8
EBU 4.0 5.6 1.3 8.0 0.0 0.0 2.3
Kimny 0.8 2.5 0.8 0.0 0.0 0.0
Fajadet left 0.5 1.3 0.5 0.0 0.0 0.0
MUTA left 0.7 0.0 1.1 0.0 0.0 0.0
Other 7.1 5.1 5.4 0.0 6.7 26.7
Cx
Judkins left 12.5 5.1 11.0 3.4 0.0 26.7
Bertrand
O
et
al.
JACC:Int
2010.
3:
1022-‐31.
24. EBU 4.0 5.6 1.3 8.0 0.0 0.0 2.3
Kimny 0.8 2.5 0.8 0.0 0.0 0.0
Fajadet left 0.5 1.3 0.5 0.0 0.0 0.0
MUTA left 0.7 0.0 1.1 0.0 0.0 0.0
Other 7.1 5.1 5.4 0.0 6.7 26.7
Cx
Judkins left 12.5 5.1 11.0 3.4 0.0 26.7
XB 3.0 6.5 6.3 4.9 13.8 13.3 1.2
XB 3.5 20.8 30.4 21.3 17.2 20.0 8.1
Amplatz left 10.8 3.8 13.0 10.3 6.7 5.8
Tiger II 0.3 0.0 0.3 0.0 3.3 0.0
EBU 3.5 26.1 26.6 25.1 48.3 43.3 25.6
EBU 3.75 6.2 15.2 6.1 3.4 6.7 7.0
EBU 4.0 8.7 2.5 11.8 0.0 3.3 3.5
Kimny 0.8 1.3 1.0 0.0 0.0 0.0
Fajadet left 0.5 2.5 0.2 3.4 0.0 0.0
MUTA left 0.4 0.0 0.7 0.0 0.0 0.0
Other 6.3 6.3 4.8 0.0 3.3 22.1
RCA
Judkins right 70.2 69.6 70.3 93.1 80.0 48.8
catheter shape—48.6% and 46.8%, respectively. Not
Bertrand
O
et
al.
JACC:Int
2010.
3:
1022-‐31.
LCx
OpKons
Table 3. Diagnostic Catheters
All U.S. Canada-Europe China India Japan
LCA
Judkins left 3.5 44.9 37.8 49.4 25.8 15.2 26.4
Judkins left 4.0 21.6 14.6 23.1 12.9 0.0 35.6
Kimny 1.8 7.3 1.1 3.2 3.0 2.3
Multipurpose 6.2 4.9 4.3 45.2 0.0 11.5
Tiger/Tiger II 16.1 12.2 15.1 12.9 75.8 1.1
Amplatz left 2.2 1.2 2.9 0.0 0.0 1.1
Barbeau 0.2 0.0 0.3 0.0 0.0 0.0
Fajadet left 0.1 0.0 0.0 0.0 0.0 0.0
Other 7.0 22.0 3.8 0.0 6.1 21.8
RCA
Judkins right 4.0 58.8 46.3 64.6 38.7 12.1 52.9
Kimny 1.7 7.3 1.0 3.2 3.0 2.3
Multipurpose 6.7 7.3 4.6 45.2 0.0 11.5
25. grafts, Judkins right remains the most frequently used
catheter shape—48.6% and 46.8%, respectively. Not
EBU 3.75 6.2 15.2 6.1 3.4 6.7 7.0
RCA
EBU 4.0 OpKons
8.7 2.5 11.8 0.0 3.3 3.5
Kimny 0.8 1.3 1.0 0.0 0.0 0.0
Table Fajadet 3. left Diagnostic Catheters
0.5 2.5 0.2 3.4 0.0 0.0
MUTA left 0.4 0.0 0.7 0.0 0.0 0.0
Other All 6.3 U.6.3 S. Canada-4.8 Europe China 0.0 India 3.3 Japan
22.1
RCA
Judkins right 70.2 69.6 70.3 93.1 80.0 48.8
Amplatz right 10.2 11.4 12.0 0.0 6.7 2.3
Amplatz left 5.8 7.6 5.4 0.0 6.7 10.5
Barbeau 1.9 1.3 2.6 3.4 0.0 0.0
Kimny 1.3 3.8 1.3 0.0 0.0 0.0
Fajadet right 0.4 0.0 0.5 0.0 0.0 0.0
MUTA right 0.2 0.0 0.3 0.0 0.0 0.0
Other 9.8 6.3 7.5 3.4 6.7 38.4
Left SVG
Left bypass graft 19.4 16.5 21.0 24.1 3.3 7.0
Amplatz left 37.3 39.2 36.6 24.1 26.7 62.8
Multipurpose 6.2 8.9 4.8 6.9 30.0 2.3
LCA
Judkins left 3.5 44.9 37.8 49.4 25.8 15.2 26.4
Judkins left 4.0 21.6 14.6 23.1 12.9 0.0 35.6
Kimny 1.8 7.3 1.1 3.2 3.0 2.3
Multipurpose 6.2 4.9 4.3 45.2 0.0 11.5
Tiger/Tiger II 16.1 12.2 15.1 12.9 75.8 1.1
Amplatz left 2.2 1.2 2.9 0.0 0.0 1.1
Barbeau 0.2 0.0 0.3 0.0 0.0 0.0
Fajadet left 0.1 0.0 0.0 0.0 0.0 0.0
Other 7.0 22.0 3.8 0.0 6.1 21.8
RCA
Judkins right 4.0 58.8 46.3 64.6 38.7 12.1 52.9
Kimny 1.7 7.3 1.0 3.2 3.0 2.3
Bertrand
O
et
al.
JACC:Int
2010.
3:
1022-‐31.
26. Ikari Left Guide Catheters
Ikari
Guide
Catheters
Ikari
et
al.
J
Invasive
Cardiol
2005
;17:636-‐41
A
B
27.
28. Ikari Right Guide Catheters
Ikari
Right
A
A
B
IR: Ikari Right
Ikari-‐R
Judkins
859*73+.72,0*3+'5(-.3(*4-0.(57*5
29. Comparison
of
1
Dedicated
Radial
Catheter
Compared
to
2
Radial
Catheters
for
DiagnosKc
and
Coronary
IntervenKon
Revascularization Medicine 14 (2013) 27–31 29
Table 4
Procedural times: Comparison of 1 dedicated radial catheter compared to 2 radial
catheters for diagnostic and coronary intervention.
1 radial catheter
(n=39)
CCL2BT (min) 31 (26:39) 40.5 (37.75:50.25) b0.001
Door-to-Balloon Time (min) 74 (55:95) 95 (77.5:127) 0.041
Puncture time (min) 2 (1:4) 3.5 (2:5) 0.116
Fluoroscopy time (min) 13.9 (10.2:20.6) 20.4 (14.58:30.05) 0.025
Total Procedural time (min) 50 (43:71) 64 (55.75:83.5) 0.065
Values are median times in minutes with inter quartile range in brackets.
CCL2BT=Cardiac catheter laboratory to balloon time.
3.2. Lesion and procedural characteristics
2 radial catheters
(n=14)
P value
Lesion and procedural characteristics are shown in Table 2. Two
Malaiapan Y et al. Cardiovascular Revascularization Medicine 2013. 14: 27–31
patients from the radial cohort crossed over to a femoral approach
because of severe tortuosity of the innominate artery. The crossover
30. Backup
support
of
the
5-‐Fr
mother–child
system
Fig. 3. Backup support of the 4-Fr mother–child system When the 4-Fr child catheter
was extended 9 cm beyond the tip of the mother guiding catheter, the backup support of
the 4-in-5, 4-in-6, and 4-in-7 systems significantly increased compared with when the mother
guiding catheter was used alone (*P 0.05, †P 0.0001). The 4-in-8 system showed no
significant increase in backup support.
Backup support of the 5-Fr mother–child system
the 5-Fr child catheter was extended #5 cm beyond
of the mother guiding catheter, the backup support
5-in-6 and 5-in-7 systems significantly increased
9 cm beyond the tip of the mother catheter, the backup
support of the 5-in-6 system was significantly greater than
that provided by Takeshita
the 7-Fr S
guiding et
al.
CCI catheter 2012. 80:292–alone 297.
(†P 0.0001),
and it was similar to that obtained with the 8-Fr catheter
39. disease
atherosclero-sis.
more re-sistant
most
calcific
arteriosclerosis
arterioscle-rosis
stenosis that
from
techniques
operators as
appreciate
trees. If
interventional col-league
interventional
The severity of spasm is a clinical and procedural
Balloon
outcome related Assisted
definition. Tracking
Initial failure (to BAT)
pass
through an arterial region may be a manifestation of
Fig. 2. Assembly of BAT technique. [Color figure can be viewed
in the online issue, which is available at wileyonlinelibrary.com.]
Patel
T
et
al.
CCI
Oct
2013.
40. correctly, a
threatening
spontane-ously,
oper-ator.
pain
where
iatro-genic
down
patient
in the
disease
atherosclero-sis.
more re-sistant
most
calcific
arteriosclerosis
arterioscle-rosis
that
from
techniques
operators as
appreciate
trees. If
col-league
interventional
chances for
has
cathe-ters
passage
RA and BA Vascular Complexities 3
SPECIFIC ANATOMICAL CHALLENGES
Radial Artery Spasm
Beginning radial operators are often apprehensive
about RA spasm. True RA spasm is not as common as
most interventionalists think and is associated more
commonly with those operator with the least experi-ence.
The overall incidence in experienced hands is
about 5.6%, of which 0.5% patients had severe spasm
[6,14,16,18,25]. A classification of RA spasm is shown
in Table II.
The severity of spasm is a clinical and procedural
outcome related definition. Initial failure to pass
through an arterial region may be a manifestation of
Fig. 2. Assembly of BAT technique. [Color figure can be viewed
in the online issue, which is available at wileyonlinelibrary.com.]
TABLE II. Classification of Radial Artery Spasm
Grade I Mild spasm Minimal pain and/or discomfort along
the course of RA during and/or
immediately after the procedure.
Grade II Moderate spasm Significant pain and discomfort along
58. Case
Summary
• If
you
have
a
perforaon-‐
do
not
bail
to
the
femoral
• Use
an
0.014”
wire
and
BAT
and
connue
• Catheter
tamponade
will
heal
vessel
by
end
of
the
case
• Use
a
Guideliner
to
improve
your
support
• Consider
balloon
anchoring
to
advance
equipment
59. Summary
• Mean
RAD
is
approx.
2.6
mm
(6F
OD
=
2.5
mm,
7F
OD
=
2.9
mm)
• Sheath
diameter
Radial
artery
minimizes
RAO
• If
large
bore
is
needed
consider
either
– thin
walled
sheaths
or
– a
sheathless
technique
(negoate
the
transion)
• Choice
of
Guide
Catheters
• Pick
one
and
get
comfortable
• Negoate
Radial/Brachial/Subclavian
Loops
• Learn
when
to
bail
to
a
different
access
route
« Use
fingers
not
wrist
for
catheter
manipulaon
« Maintain
the
0.035”
wire
in
catheter
during
manipulaon
60. 3rd
Advanced
Internaonal
Masterclass
AimRADIAL2014
Chicago,
IL
October
23-‐25
GUIDE
CATHETER
SELECTION
FOR
RADIAL
PCI
Thursday
October
23,
2014,
2:25
to
2:40
pm
Prashant
Kaul,
MD,
FACC,
FSCAI
Assistant
Professor
of
Medicine
University
of
North
Carolina,
Chapel
Hill
Medical
Director,
Chest
Pain
Center
Associate
Director,
Intervenonal
Cardiology
Training
Program