Kanovsky J - AIMRADIAL 2013 - OCT for radial injury


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Radial artery acute injury after PCI assessed by optical coherence tomography

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Kanovsky J - AIMRADIAL 2013 - OCT for radial injury

  1. 1. RADIAL ARTERY ACUTE INJURY AFTER PCI ASSESSED BY OPTICAL COHERENCE TOMOGRAPHY Kanovsky J., Poloczek M., Bocek O., Miklik R., Jerabek P., Ondrus T., Spinar J., Kala P. Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic  AimRADIAL2013, New York
  2. 2. Disclosure: Jan Kanovsky, MD, PhD  Dr. Jan Kanovsky has no relevant financial interests to disclose AimRADIAL2013, New York
  3. 3. Background Importance of RA condition  The number of transradial coronary catheterizations and interventions is increasing  The quality of the radial artery (RA) is crucial if used for the coronary artery bypass graft (CABG)  The number of patients with more than one arterial conduit used for the CABG is increasing  RA native disease is a predictor of coronary thin-cap fibroatheroma (TCFA)1 1 Di Vito, 2013 AimRADIAL2013, New York
  4. 4. Background OCT  Optical coherence tomography (OCT) is intravascular imaging method with the highest resolution available (up to 10um)  OCT of RA can provide detailed information about acute injury or chronic changes of the vessel after transradial catheterization1 1 Yonetsu, 2010 AimRADIAL2013, New York
  5. 5. TD-OCT study (Yonetsu, 2009)  High number of intimal tears and medial dissections  Using 16cm sheath, for imaging pulled 14cm out  Most of the injuries in the distal segment 1 Yonetsu, 2010 AimRADIAL2013, New York
  6. 6. Methods  40 consecutive patients admitted for coronary angiography (CAG) due to non-STEMI diagnosis  First myocardial lesion in patients’s history  First transradial CAG  Informed consent Exclusion: STEMI, previous MI, acute heart failure, left main disease, renal insufficiency AimRADIAL2013, New York
  7. 7. Methods  6F 7cm sheath  Pulled back of 3cm, guiding catheter moved back into the sheath  FD-OCT recording of RA, starting 8cm from the sheath tip (using X-ray contrast ruler)  Manual injection of the 100% contrast fluid AimRADIAL2013, New York
  8. 8. Results  Only two minor injuries found (5%)  Few patients with abnormal vessel wall structure (5pts, 12,5%, intimal thickening, calcifications, qualitative assessment)  No thrombotic mass found  All patient asymptomatic AimRADIAL2013, New York
  9. 9. Injuries  Intimal tear AimRADIAL2013, New York
  10. 10. Injuries  Dissection AimRADIAL2013, New York
  11. 11. Discussion  In most of the patients (95%), we found no acute injury and normal vessel structure  Major difference in results comparing to the Yonetsu study from 2010  Two main differences – sheath length, TD vs FD OCT imaging AimRADIAL2013, New York
  12. 12. Conclusion  Transradial CAG and intervention is a safe access route, with minor incidence of acute injuries  The length of sheath is likely important for the incidence of RA injury  Chronic changes are the subject of further research in the project (all patients scheduled for 9 months follow-up CAG and OCT). AimRADIAL2013, New York
  13. 13. Thank you for your attention.  Supported by the Grant of the IGA Ministry of Health of the Czech Republic no. NT/13830. AimRADIAL2013, New York