Geisinger Medical Center is a 410-bed, level 1 trauma center in central Pennsylvania. We have been designated as an Accredited Chest Pain Center with PCI by the Society of Chest Pain Centers and have been voted, for the 4th time, one of the nation’s top 100 cardiovascular hospitals by Thomson Reuters. We recently obtained Magnet designation by the American Nurses Credentialing Center. Our hospital was founded in 1915 and is one of the largest rural healthcare facilities in the United States. Our care spans through 40 counties, reaching 2.5 million residents of central and northeast Pennsylva

Could FAME lead the way for PCI to show superiority over medical therapy and CABG for multivessel coronary artery disease?

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What were the results of the FAME (Fractional Flow Reserve versus Angiography for Guiding PCI in Patients with Multivessel Coronary Artery Disease) trial1?

The FAME study was a large, multicenter, prospective, international study, randomizing patients with multivessel coronary artery disease to two different strategies to decide which lesions to stent. One strategy was based on the current, most common method, which is u

In a recent article in Cath Lab Digest, Cooper1 reported a “typical case” of a patient with unstable, recent-onset angina, who had a “high-risk” coronary artery anomaly (CAA) that the author deemed to “require surgical treatment.” He stated that the best treatment for this condition was coronary bypass surgery and proximal ligation of the anomalous artery, which were indeed carried out.

After reviewing the coronary catheter angiographic images and computerized axial tomographic angiographic (CTA) images that nicely illustrate Cooper’s article, I have concluded that even the

Use of Temporary Percutaneous Left Ventricular Support in a
Patient with Profound Cardiogenic Shock from a Non-Ischemic Cardiomyopathy

Summary

We report a case involving a 61-year-old man who presented with profound cardiogenic shock secondary to a non-ischemic cardiomyopathy. The use of temporary percutaneous left ventricular support with the Abiomed Impella 2.5 circulatory support device restored acceptable hemodynamics, improved cardiac output, reduced left ventricular wall tension, and improved myocardial perfusion, allowing left ventricular recovery over the ensuing

What does “platelet resistance” mean?

A better term to use would be clopidogrel non-responsiveness, or, even more specifically, high platelet reactivity while on clopidogrel (Plavix) therapy. Clopidogrel exerts its anti-platelet effect by blocking the platelet P2Y12 receptor. In the body, ADP binds this receptor (i.e., is an agonist), resulting in platelet activation and aggregation. “On-treatment reactivity” refers to the strength of the platelets’ response when exposed to ADP while on clopidogrel therapy. Classically, we can measure this ex vivo, or outside the body, by d

I’m new to the cath lab, and I can’t figure out why a physician uses monorail one time and over the wire the next. What’s the reason?

— CVT student, New York

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If you’ve read these articles over the last couple of years, you will have heard this before: “It’s all physician preference.” Unfortunately, in this case, the same answer applies. With a couple of exceptions addressed later, the use of a monorail system versus an over-the-wire system is physician preference.

If you ask physicians, they will give you their op

The authors share the results of a study done at their facility comparing the AVD ComfortPress device with manual compression in patients receiving a 4 Fr arterial sheath.

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In the interest of quality improvement and safety, new technology, techniques and equipment are often examined and evaluated by nursing staff at Barnes-Jewish Hospital at Washington University Medical Center (a Magnet hospital). In 2007, such an opportunity arose when a new product, the ComfortPress™ Manual Compression Assist Device [Advanced Vascular Dynamics (AVD), Portland, OR]

Dr. Mauricio Cohen has been performing transradial access procedures for approximately 5 years. After joining the University of Miami Hospital cath lab in January of 2009 as director, he instituted a transradial program.

Dr. Cohen, where did you first learn transradial access?

I was exposed to these procedures during my training in Argentina back in the mid-1990s. In 1994-95, we did a randomized study looking at radial, brachial and femoral access, and it was during this study that I was exposed to transradial access. I learned the nuts and bolts of the transradial procedure, but

New technology’s impact on hospitals across the country is increasing, mostly in terms of facility design requirements, physician satisfaction, and community image and reputation. Though exciting, the adoption of new technology can be somewhat of a challenge. These decisions can make the difference between your cardiovascular service line or catheterization lab being considered ‘cutting edge’ or in some cases, ‘cutting floor.’

Decisions, Decisions

Indeed, choices about what technology or new equipment to consider, if and when to purchase, and how to implement are signif

I would like to emphasize the importance and value of continuing education. Why should we consider continuing education, other than it being mandatory in some areas? As professionals, we must strive to be lifelong learners and to stay current in our field. The easiest way to accomplish this goal is to complete continuing education (CE) offerings throughout the year.

Continuing education should be challenging and help us to maintain current information. Within the healthcare field, technology and treatment protocols can change daily. We all have demanding jobs and often find it difficult to