Radial Approach International Perspective Syllabus
Radial Approach International Perspective Syllabus Radial_Approach_International_Perspective_Syllabus Radial_Approach_International_Perspective_Syllabus 6 2013 pdfdoc 258413772373414384 3:
2013-06-03
: Pdf Radial Approach International Perspective Syllabus Radial_Approach_International_Perspective_Syllabus 6 2013 pdf
Open the PDF directly: View PDF 
.
Page Count: 51
| Download | |
| Open PDF In Browser | View PDF |
6/1/2013 Balloon Assisted Tracking for Challenging Anatomy Tejas M. Patel, MD, DM, FACC, FESC, FSCAI Chairman & Chief Interventional Cardiologist, Apex Heart Institute, Professor & Head, Department of Cardiology, Sheth V. S. General Hospital, Ahmedabad, India. Professor of Medicine (Cardiology), Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, USA. Disclosure • I have no relevant disclosure related to this presentation Balloon-assisted tracking of a guide catheter through difficult radial anatomy: A technical report Patel T, Shah S, Pancholy S. Catheter Cardiovasc Interv. 2013 Apr;81(5):E215-8. 1 6/1/2013 Balloon-assisted tracking: A must-known technique to overcome difficult anatomy during transradial approach Patel T, Shah S, Pancholy S, Rao S, Bertrand OF, Kwan T. Catheter Cardiovasc Interv. 2013 Apr 16. doi: 10.1002/ccd.24959. [press] 2 6/1/2013 Working through small RA & 7F guide 3 6/1/2013 Working through complex tortuosity of RA 4 6/1/2013 Another Example 5 6/1/2013 Perforation of RA & Subclavian tortuosity 6 6/1/2013 7 6/1/2013 8 6/1/2013 Another Example 9 6/1/2013 10 6/1/2013 Working through 360 degree loop 11 6/1/2013 Another Example 12 6/1/2013 Thank You www.transradialworld.com 13 31.5.2013 Radial access for STEMI - Case Ivo Bernat MD, Ph.D. University Hospital and Faculty of Medicine Pilsen, Czech Republic Disclosure Statement of Financial Interest I, Ivo Bernat DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Primary PCI in Europe Primary 22 PCI Centers - no thrombolysis in CZ … Widimsky et al. Eur Heart J 2010; 31,943-957 1 31.5.2013 All Czech PCI centers (n=22) - 24/7 service for AMI since 2002 Trend in the use of radial approach in CZ (PCI) 60% % of radial approach 50% 40% 30% Stable CAD 20% ACS – Non-STE ACS – STEMI 10% Others 0% Total : 2005 2006 2007 2008 2009 2010 6/2011 5%......10%....17%.....21%.....32%.....42%....50%...2012 >50% Case from Sunday evening - May 26, 2013 • • • • • woman - 76 y. treated hypertension - betabl. + ACEI 2 hours of chest pain anterior STEMI EMS: UFH 5000 IU i.v., clopidogrel 600 mg p.o., Aspegic 250 mg i.v. • direct transport to our cathlab • Our PCI center : 95% TRA incl. STEMI - 90% from the left 2 31.5.2013 ECG before pPCI Left radial approach - 80% AS l.sin. stenosis Question - go on from the left ? 3 31.5.2013 Angled hydrophilic wire 0.035 …. CAG with 5F dg. Tiger catheter Next step - 5F guiding XB 3,5, bolus GPI, coronary wire… 4 31.5.2013 … minimal predilatation (2,0/20mm with 4atm) DES 3.0/16 implantation - 18 atm After primary PCI … 5 31.5.2013 Next step - tight subclavian stenosis - to treat or not to treat …..??? Stent 6,0/14mm (18 atm = 6,99mm) without guiding catheter … Final result of pPCI and subclavian stenting 6 31.5.2013 After primary PCI and subclavian stenting (contrast 150 ml, skia 9.8 min) • radial artery compression time - 100 min • complications - 0 • echo next day - LVEF 45% • ICU stay - 32 hours (Sunday midnight - Tuesday morning) Conclusion • Transradial primary PCI (in experience radial center) is the best way how to : • • - minimize local bleeding - increase patient comfort with soon mobilisation and earlier discharge • • - reduce the cost - also reduce mortality Additional non coronary intervention in our case was safe and easy. 7 6/2/2013 Complex transradial LEFT MAIN PCI in CARDiogenic shock Olivier F. Bertrand, MD, PhD Associate-Professor of Medicine, Laval University Adjunct-Professor, Department of Mechanical Engineering, McGill University International Chair on Interventional Cardiology and Transradial Approach QuickTime™ and a YUV420 codec decompressor are needed to see this picture. Quebec Heart-Lung Institute VuMedi-June 3, 2013 Disclosures • Consultant: OPSENS Case Scenario • 57 y old man, crushing chest pain while working on his roof • RF: Smoker • ECG in ambulance: Antero-Lateral STEMI • VF 2 episodes during transfert. Cardiogenic shock upon arrival in cath lab 1 6/2/2013 QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. 2 6/2/2013 QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Key points • Radial access permits complex LM PCI • Having the groins prep during cardiogenic shock allows quick access for LV support (BIA, ECMO, LVAD, Impella) and PCMK • Biggest challenge remains to get the radial access when faint/no pulse. Role for ultrasound guidance ? 3 6/2/2013 WWW.aimradial.org 4 01.06.2013 Radial Access for Carotid Interventions Sasko Kedev MD, PhD, FESC, FACC University Clinic of Cardiology Skopje, Macedonia skedev@gmail.com DISCLOSURE Nothing to disclose Potential Vascular Complication Femoral Approach Hematoma-bleeding Pseudoaneurysm RetroPeritoneal Hemorrhage AV fistula Ischemia-Thrombosis-Emboli Infection Neuropathy Skin crease CFA 1 01.06.2013 ACCESS SITE COMPLICATIONS Vascular access is 1st reason of bleeding complications & MACE after PCI BLEEDING INCREASES MORTALITY ! ! ! Radial Artery Access 2 01.06.2013 FEMORAL APPROACH LIMITATIONS for CAS Aorto-iliac disease or occlusion Previous surgical bypass at this level Diseased and Complex aortic arch with Tortuous SAA originating from elongated, or type II, III, or bovine aortic arch Aorto-iliac Disease or Occlusion Tortuous SAA Originating from Elongated or Bovine Aortic Arch 3 01.06.2013 ACCESS SITE COMPLICATIONS The most common adverse event after CAS from the femoral approach MOST TECHNICAL FAILURES ARE RELATED TO A COMPLEX ARCH Risk of catheter-related emboli in patients with atherosclerotic debris in the thoracic aorta Karalis DG et al. Am Heart J. 1996 Jun;131(6):1149-55. Alternatives to FA Brachial Radial / Ulnar Direct puncture 4 01.06.2013 Radial Access - Alternatives Right Radial Artery is 1st choice ! Right Ulnar Artery Left Radial Artery Left Ulnar Artery TRANSRADIAL CAS IMPORTANCE OF EARLY AMBULATION Patient comfort and satisfaction Reduced nursing cost Reduced vagal reaction Reduced hypotensive response Reduced bleeding complications 5 01.06.2013 TRANSRADIAL CAS Anchoring technique Telescopic approach TRANSRADIAL CAS Anchoring Technique SIM 1-3 in CCA Long hydrophilic GW in ECA Exchange with transfer catheter Exchange with extra stiff GW in ECA Advance 6F GS in CCA TRA CAS of RICA in a patient with Acute Carotid Syndrome 6 01.06.2013 Case 1. Left ACC 100% RICA Terumo advantage wire in RECA 7 01.06.2013 Amplatz Stiff wire in RECA Destination sheath 6Fr Xact 8-6/40mm 8 01.06.2013 Final result TRANSRADIAL CAS Anchoring technique Telescopic approach Case 2. SIM 2 Cook into Shuttle Sheath 9 01.06.2013 Shuttle Sheath Positioning LICA 95 % Final Result 10 01.06.2013 Before / After TRANSRADIAL CAS Direct Cannulation Simple Loop Cannulation Deep Loop Retrograde Cannulation TRANSRADIAL CAS Direct Cannulation Simple Loop Cannulation Deep Loop Retrograde Cannulation 11 01.06.2013 Case 3. CAS of RICA – Direct cannulation CAS of RICA – Final Result Before / After 12 01.06.2013 TRANSRADIAL CAS Direct Cannulation Simple Loop Cannulation Deep Loop Retrograde Cannulation Case 4. CAS of LICA – Simple Loop Cannulation CAS of LICA - Final Result 13 01.06.2013 Before / After TRANSRADIAL CAS Direct Cannulation Simple Loop Cannulation Deep Loop Retrograde Cannulation Case 5. TRA CAS of LICA – DLRC – Transfer Catheter 14 01.06.2013 TRA CAS of LICA – DLRC – Transfer Catheter TRA CAS of LICA – DLRC – 5F JR GC TRA CAS of LICA – DLRC – 7F MP GC 15 01.06.2013 TRANSRADIAL CAS Right Wrist Access Left Wrist Access Case 6. Left TRA CAS of RICA – Simple Loop Cannulation Left TRA CAS of RICA – Final Result 16 01.06.2013 Before / After TRANSRADIAL CAS Tortuous Internal Carotid Artery String Sign Contralateral Occlusion Case 7. Tortuous LICA Subocclusion in Octogenarian 17 01.06.2013 Stent: Precise 7.0/40mm Final Result Before / After 18 01.06.2013 Case 8. LICA: String sign Final result Before / After 19 01.06.2013 Case 9. TUA for CAS of LICA with contralateral occlusion Male J. A. 66 y.o. High Puncture of Ulnar Artery High Puncture of Ulnar Artery: High Take-off of Radial Artery 20 01.06.2013 RICA 100% Destination sheath 6Fr Final Result 21 01.06.2013 Final Result Before / After Case 10. TRA CAS of LICA with MoMa proximal protection Male M. D. 66 y.o. 22 01.06.2013 TRA LICA 90% 23 01.06.2013 MOMA proximal protection device Stent: Precise RX 8.0/30mm Final result 24 01.06.2013 Before / After Radial Approach - Hemostasis Transradial CAS ADVANTAGE Easy access in otherwise very complex aortic arcs Immediate patient mobilisation Reduced hypotensive response No bleeding Anticoagulation is not an issue Reduced nursing cost Outpatient performance in selected cases 25 01.06.2013 Transradial CAS DISADVANTAGE Significant learning curve for new TRA operators Sometimes longer procedure for “easy case” with type I aortic arch Proximal PD and larger devices could not be used freely in all cases Radial artery occlusion ≈ 10 % Transradial CAS MISTAKE Perform TRA only when FA is not possible !!! Conclusions I TRA & TUA CAS is feasible and safe when performed by experienced TRA operator Easy access in difficult anatomies (bovine arch LCCA)and most of the innominate artery take offs Severe angulations at the origin might be negotiated safely and efficiently with DLRC as alternative of Direct and Simple Loop cannulation for CAS 26 01.06.2013 Conclusions II Allows early patient mobilization Eliminates bleeding complications Further studies are needed before recommending wrist access (TRA or TUA) for CAS as primary approach over femoral access 27
Source Exif Data:
File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.4 Linearized : No Page Count : 51 Creator : PDFMerge! (http://www.pdfmerge.com) Producer : iText® 5.4.1 ©2000-2012 1T3XT BVBA (ONLINE PDF SERVICES; licensed version) Modify Date : 2013:06:03 00:50:16-04:00 Create Date : 2013:06:03 00:50:16-04:00EXIF Metadata provided by EXIF.tools