Radial Artery Occlusion:      Prevention and Treatment     Olivier F. Bertrand, MD, PhD     Associate-Professor of Medicin...
Plan                   Scope of the problem                   Prevention                         Anticoagulation (agent, d...
Upper Limb Vascularization                             FUJII ET AL. J INV CARDIOL 2010;22:536-40Friday, September 30, 2011
Radial Artery OcclusionFriday, September 30, 2011
WHICH TEST PRIOR TRA ?                                           BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, Septem...
TO PREVENT RADIAL OCCLUSION, HEPARIN ?                                                 BERTRAND OF ET AL. JACC INTV 2010;3...
WHICH METHOD TO ASSESS RAO ?                                             BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday...
Radial Artery OcclusionFriday, September 30, 2011
Radial Artery Occlusion                                       Comp     Device        TR/Raco       All   Enreg. (All)     ...
Hemostasis Techniques                                   BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, September 30, 2...
Hemostasis DevicesFriday, September 30, 2011
RAO: Anticoagulation Agent                             PCI   ANGIO   N = 400                                              ...
RAO Prevention: IV or IA?Friday, September 30, 2011
Friday, September 30, 2011
RAO Prevention: PROPHET IFriday, September 30, 2011
“Patent Hemostasis” Protocol                              ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
“Patent Hemostasis” Protocol                              ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
“Patent Hemostasis” Protocol                              ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
RAO Pathophysiology                 Acute thrombosis favored by vessel trauma                 and flow reduction during pro...
Radial Artery Occlusion        ACUTE                    CHRONIC                                           ADAPTED FROM S. ...
“Acute” RAO Therapy                       1) VERIFY RADIAL ARTERY PATENCY POST-HEMOSTASIS                              2) ...
“Pharmacological” RAO TherapyFriday, September 30, 2011
Retrograde Recanalization                 MALE, 38 Y          RAO POST STAGED RCA PCI            FAILED ULNAR COMPR.      ...
Retrograde Recanalization                 MALE, 38 Y          RAO POST STAGED RCA PCI            FAILED ULNAR COMPR.      ...
Retrograde RecanalizationFriday, September 30, 2011
Retrograde RecanalizationFriday, September 30, 2011
Patent Hemostasis with Assisted Ulnar OcclusionFriday, September 30, 2011
Post Retrograde RecanalizationFriday, September 30, 2011
1 Week Post-RecanalizationFriday, September 30, 2011
Conclusion               Prevention of RAO is part of optimal TRA care               Best preventive methods = anticoagula...
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Radial Artery Occlusion: Prevention and Treatment

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Bertrand OF

  1. 1. Radial Artery Occlusion: Prevention and Treatment Olivier F. Bertrand, MD, PhD Associate-Professor of Medicine, Laval University Adjunct-Professor, Department of Mechanical Engineering, McGill University Quebec Heart-Lung Institute RITA PRAGUE, SEPTEMBER 2011Friday, September 30, 2011
  2. 2. Plan Scope of the problem Prevention Anticoagulation (agent, dose, route) catheter/artery ratio Hemostasis devices and technique Treatment Pharmacological Non-PharmacologicalFriday, September 30, 2011
  3. 3. Upper Limb Vascularization FUJII ET AL. J INV CARDIOL 2010;22:536-40Friday, September 30, 2011
  4. 4. Radial Artery OcclusionFriday, September 30, 2011
  5. 5. WHICH TEST PRIOR TRA ? BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, September 30, 2011
  6. 6. TO PREVENT RADIAL OCCLUSION, HEPARIN ? BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, September 30, 2011
  7. 7. WHICH METHOD TO ASSESS RAO ? BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, September 30, 2011
  8. 8. Radial Artery OcclusionFriday, September 30, 2011
  9. 9. Radial Artery Occlusion Comp Device TR/Raco All Enreg. (All) 20 15 RAO (%) 10 Bracelet- type Bandage TR Band 5 0 0 90 180 270 360 DaysFriday, September 30, 2011
  10. 10. Hemostasis Techniques BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, September 30, 2011
  11. 11. Hemostasis DevicesFriday, September 30, 2011
  12. 12. RAO: Anticoagulation Agent PCI ANGIO N = 400 CCI 2010;76:654-8Friday, September 30, 2011
  13. 13. RAO Prevention: IV or IA?Friday, September 30, 2011
  14. 14. Friday, September 30, 2011
  15. 15. RAO Prevention: PROPHET IFriday, September 30, 2011
  16. 16. “Patent Hemostasis” Protocol ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
  17. 17. “Patent Hemostasis” Protocol ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
  18. 18. “Patent Hemostasis” Protocol ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
  19. 19. RAO Pathophysiology Acute thrombosis favored by vessel trauma and flow reduction during procedure ± inadequate anticoagulation... (minutes!) Clot formation favored by occlusive hemostasis...(Hours) Persisting occlusion leads to organizing thrombus, then late chronic fibrotic occlusion... (Days-weeks)Friday, September 30, 2011
  20. 20. Radial Artery Occlusion ACUTE CHRONIC ADAPTED FROM S. PANCHOLYFriday, September 30, 2011
  21. 21. “Acute” RAO Therapy 1) VERIFY RADIAL ARTERY PATENCY POST-HEMOSTASIS 2) IF RAO, 1-HOUR ULNAR COMPRESSION BERNAT I ET AL. AM J CARDIOL 2011;107:1698-1701Friday, September 30, 2011
  22. 22. “Pharmacological” RAO TherapyFriday, September 30, 2011
  23. 23. Retrograde Recanalization MALE, 38 Y RAO POST STAGED RCA PCI FAILED ULNAR COMPR. FAILED LMWHFriday, September 30, 2011
  24. 24. Retrograde Recanalization MALE, 38 Y RAO POST STAGED RCA PCI FAILED ULNAR COMPR. FAILED LMWHFriday, September 30, 2011
  25. 25. Retrograde RecanalizationFriday, September 30, 2011
  26. 26. Retrograde RecanalizationFriday, September 30, 2011
  27. 27. Patent Hemostasis with Assisted Ulnar OcclusionFriday, September 30, 2011
  28. 28. Post Retrograde RecanalizationFriday, September 30, 2011
  29. 29. 1 Week Post-RecanalizationFriday, September 30, 2011
  30. 30. Conclusion Prevention of RAO is part of optimal TRA care Best preventive methods = anticoagulation, small catheters (C/A ratio!), controlled “active” hemostasis Distal ischemia can be due to emboli >> RAO Early intervention probably provides best chance of success Other therapies to be tested: Rx ultrasound, direct thrombin inhibitor, ...Friday, September 30, 2011

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