CLINICAL EVENTS CALENDAR
- StartMay 19,2009EndMay 22,2009EuroPCR: Barcelona, Spainwww.europcr.com
- StartJun 04,2009EndJun 06,2009Third Annual Left Main and Bifurcation Summit: NY, NYwww.crf.org
- StartJun 11,2009EndJun 11,20092009 Vascular Annual Meeting (SVS): Denver, COwww.vascularweb.org
- StartJun 18,2009EndJun 21,2009Multidisciplinary European Endovascular Therapy (MEET): Cannes, Francewww.meetcongress.com
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE On Demand Web Archive Non-Accredited Target Audience: Physicians, nurses, and technologists. This activity is supported by an educational grant from Terumo Medical Corporation. |
Clinical Editor's Corner
Radial Artery Catheterization: The way to go
Last month, I visited Dr. Olivier Bertrand at Laval Hospital in Quebec City, Canada, to present a talk on coronary physiology. He and his team showed me their lab and method of performing radial artery catheterization for their 10,000 patients of 2008-2009, with 3,500 percutaneous coronary interventions (PCIs) from the same approach. They reported no retroperitoneal hematomas, femoral pseudo aneurysms, fistula or femoral artery bleeds, occlusions or emboli. The complications from radial artery access are trivial compared to femoral, with <4% loss of radial artery pulse as the worst of it. I was forced to reconsider my old ways. Why do I persist with femoral artery access when complications from radial access are so much lower? If I said, hypothetically, that the left femoral approach had 10 times the complications as the right, I would never go to the left. If I now say the femoral artery has 10 times the complications compared to the radial approach, why would I ever use the femoral?
Do We Need Platelet Function Testing in Percutaneous Coronary Intervention?
A 68-year-old man was admitted for acute ST-elevation inferior myocardial infarction after right coronary artery stenting (3.0 x 18mm drug-eluting stent) four months ago. He had been taking 81 mg of aspirin and 75 mg of clopidogrel orally on a daily basis. He is treated for hypertension and hypercholesterolemia, but not diabetes. He does not smoke. The angiogram demonstrated thrombosis in the stent. He underwent thromboaspiration, intravascular ultrasound of the thrombosed stent and balloon high-pressure inflations with a 3.5 x 15mm NC balloon. Did this patient have clopidogrel (Plavix)/aspirin (ASA) resistant platelets? Should the future doses of clopidogrel/ASA be increased over the standard doses on presumption of insufficient platelet response to dual antiplatelet therapy? Should platelet function be routinely tested?
Definition of Platelet Resistance
Stimulating Medical Simulation
My interventional cardiology recertification is due this year. To fulfill my American Board of Internal Medicine (ABIM) requirements of training, practice and didactic material, I need 100 self-evaluation points obtained from practice improvement modules or interventional cardiology simulations. At the American College of Cardiology (ACC) meeting this past March in Orlando, Florida, the Medical Simulation Corporation* offered cardiac cath simulations to help physicians acquire this 20-point unit.
For those who have never worked on a cath simulator, I wanted to provide some background and share my first simulator experience.
First, what is simulation?
Do I Need to Wear a Hat and Mask in the Cath Lab?
How sterile does the cardiac catheterization laboratory have to be? In the initial years of catheterization at The Cleveland Clinic, Mason Sones was seen performing the procedure in a sterile gown and glove with a sterile mosquito clip at his side in case he wanted a cigarette. Although this may be an exaggeration, the general catheterization procedure is considered a “clean” procedure performed outside of an operating room. With the evolution of the interventional field, the cath lab now needs operating room (OR) sterility for the complex and device-related procedures such as atrial septal defect (ASD) closure devices, implantable peripheral stents, and pacemakers and automated implantable cardioverter defibrillators (AICDs).
Are the data to support instituting a complete 24-hour/7-day-a-week sterile environment available?
Are Vascular Closure Devices Risk Factors For Retroperitoneal Hemorrhage?
Retroperitoneal hemorrhage (RPH) is a potentially fatal complication and is most often related to invasive cardiac procedures using the femoral artery access route. RPH rarely occurs spontaneously. For cardiac cath procedures, RPH is more often related to a cranially positioned (high) arterial puncture, a location which cannot be determined with certainly beforehand since femoral anatomy is variable and the puncture technique is performed in a blind manner (i.e. no ultrasound guidance).
RPH is most commonly seen in association with patients with anticoagulation therapy, bleeding abnormali
Conscious Sedation in the Cath Lab: Should we use what GI uses?
How much is enough conscious sedation (CS) for a cardiac catheterization procedure? Each lab likely has its own regimen. In our lab, most of our patients receive preprocedural oral valium (5mg) and Benadryl (25mg). In the lab, before the vascular access, we give versed (1-2mg) and fentanyl (25-50mcg) intravenously. Our patient is generally comfortable, sleepy, but can be aroused and conversant enough to tell us about pain or other problems. If the patient is agitated or highly anxious, we give additional doses of versed and fentanyl.
However, for GI and other procedures, the doses of CS d
Seven Questions for the Cath Lab From 2008 and the Studies That Answer Them
Our work in the cath lab moves forward when supported by better patient outcomes, better safety and better cost savings. Much of what we used to do in the cath lab has changed based on comparisons between groups of patients treated in the ‘conventional’ way with that of a potentially better method, drug or device. This year, especially in the fall after the October 2008 TCT meeting, there were many new trials presented, some of which are likely to have importance for the cardiac cath lab. I thought it would be worthwhile to take a moment and review 7 studies presented over the past year th
What’s Your Approach to New Technology? Early Adopter or Prisoner of Tribal Customs?
Technology and new information come to the cath lab nearly every month. The use of new stents and techniques in percutaneous coronary intervention (PCI) (for example, bifurcation management or thrombus aspiration methods) continues to evolve. Years of studies supporting various approaches encourage each one’s incorporation into the lab when associated with better outcomes. If such a straightforward application of technology is related to better patient outcomes and supported by excellent studies, why then are simple technologies like intravascular ultrasound (IVUS) and fractional flow reserv
Hemodynamic Data Collection at Square 1: From transducer to recorder
Hemodynamic studies require accurate data collection technique. For complex cases we record simultaneous pressure waveforms, working with multiple transducers. I have had some questions from our staff as to what is the best and easiest way to collect hemodynamic data. As a caveat, I am sure most of you already know that there is more than one way to do nearly everything in the lab, and that includes setting up and recording hemodynamics. Let’s spend a few moments addressing how we record hemodynamics in our cath lab.
I tell our fellows, “if you’re going to do it (measure hemodynamics)
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