Tips & Tricks in Interventional Cardiology Shuvanan Ray
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1Tips and Tricks in Interventional Cardiology2
3Tips and Tricks in Interventional Cardiology
Shuvanan Ray MD DM FSCI FSCAI Chief of Cardiac Intervention Fortis Hospitals Kolkata, West Bengal, India Foreword Amal Kumar Banerjee Imad Sheiban
4
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Tips and Tricks in Interventional Cardiology
First Edition: 2015
9789351528210
Printed at
5Dedicated to
My beloved wife
and
my sons Saunak and Sayak
who are a constant source of inspiration6
7Contributors 9Foreword
The number of catheter-based cardiac diagnostic and therapeutic intervention is increasing very rapidly. We have surpassed the learning curve, but now, we require to achieve high-quality practice, skill and technique in interventional cardiology.
With this objective, Dr Shuvanan Ray, one of today's most recognized interventional cardiologists in India, has written and edited Handbook of Cardiac Intervention. His tips and tricks summarizes in 15 chapters along with a number of practical concepts that, with practice, would guide and advance the skills of an interventional cardiologist in the catheterization laboratory. This book focuses on key procedures and techniques. Each strategic or tactical move is graded by complexity level and described in a simple, step-by-step approach that includes guidance on how to overcome practical difficulties and navigate particularly challenging clinical scenarios and complications.
I hope, it would offer interventional cardiologists, fellows in interventional cardiology, Cath Lab nurses and technicians, tips and tricks gathered from the personal experience of an interventional cardiology expert and also guide on the latest procedures and techniques, performing challenging interventions, and managing complications and other difficult situations where evidence may be limited or inconsistent.
Amal Kumar Banerjee
MD DM FACC FESC FACP FAPSC FICC FCSI FICP
Consultant and Interventional Cardiologist
Formerly
Institute of Cardiovascular Sciences
IPGME&R, SSKM Hospital, Kolkata, West Bengal, India
Past President
Cardiological Society of India
Association of Physicians of India
SAARC Cardiac Society10
11Foreword
The advent of percutaneous coronary intervention (PCI) introduced by Andreas Grüntzig in 1977 with balloon angioplasty, has been able to change quickly our clinical practice in cardiology particularly in the management of patients with coronary artery disease. Technical development of PCI was immensely fast allowing the introduction of alternative percutaneous approaches to balloon angioplasty (atherectomy, laser, stents). Thus, interventional cardiology has greatly proliferated in the last two decades becoming the first approach in managing coronary artery disease.
In 2005, more than two million PCI procedures were performed worldwide. This exponential growth in interventional cardiology has been possible because of: (1) continued refinement in technique and the advent of new devices to improve the success and safety of PCI, (2) expanded indications by well-defined randomized clinical trials, and (3) dramatically reduced rates of restenosis by the advent of drug-eluting stents (DES). Despite the increasing complexity of cases, the outcome of PCI has continued to improve and more importantly the need for urgent bypass surgery resulting from PCI complications has been almost eliminated, pushing this field further by allowing freestanding catherization laboratories to perform PCI without on-site surgery. Interventional cardiologists have now expanded their skills outside of coronary tree to include structural interventions (ASD, VSD, PFO, valvular heart disease) and peripheral interventions (carotids, subclavian, renal, iliac).
This handbook has compiled a group of expert authors guided by Dr Shuvanan Ray to provide an updated view in this ever-changing and growing field of interventional cardiology and to provide tips and tricks learnt from experience to face some technical difficulties in everyday practice particularly of help for young interventionalists at the beginning of their experience. I know Dr Shuvanan Ray from more than one decade since he was visiting our Center at the University of Turin (Italy) for several times and having the opportunity to work and discuss togother complex approaches. His experience grew up exponentially becoming one of the most renowned interventional cardiologists in India. His passion and dedication in this field is a warranty for the high quality of this handbook dedicated to all cardiologists who desire to learn and grow up in interventional cardiology starting from clinical indication to other important topics such as procedural access, hemodynamics, optimal coronary angiography, basic materials for PCI (guiding catheters, wires, balloons, stents), lesion evaluation by intravascular ultrasound and fractional flow rate (FFR), drugs used in Cath Lab and emergency situation. Lesion-specific approaches using various debulking and thrombectomy devices, bifurcation lesions, ostial lesions, calcified lesions, thrombus-containing lesions and total occlusions are discussed in detail with practical tips and tricks. The section on balloon valvuloplasty and congenital heart disease in adults provides the update 12of various specific approaches and results. Finally, complications of PCI and their management in the Cath Lab are emphasized to continue to both do the best safely and to prevent undesired complications.
The authors have made all efforts to provide this excellent handbook for the interventional cardiologists, fellows, and support staff. Undoubtedly, it will serve as an important reference resource for those who are participating in the field of interventional cardiology and I am sure will provide an important support for further growth of interventional cardiology in India.
Imad Sheiban MD
Associate Professor
Director, Interventional Cardiology
Pederzoli Hospital
Via Monte Baldo 24
Peschiera del Garda VR, Italy
13Preface
Interventional cardiology has become an established specialty since its dramatic beginning in 1977, when Dr Andreas Grüntzig read his remarkable paper to the American College of Cardiology Meeting held in Miami, Florida, USA. In India, it came a decade later and spread exponentially through the angioplasty training courses, workshops and meetings held by the pioneers in the field. As a beginner, a young cardiologist having a postgraduate degree in cardiology, which demands extensive information and reading of congenital, valvular and cardiac muscle diseases and trained mainly in noninvasive procedures, looks at intervention with awe and hesitation and finds it a difficult and challenging subject.
There are extensive textbooks on interventional cardiology at our disposal, which require almost a lifetime to complete; so cannot be advised to cover up all, before one starts intervention. Learning from them should continue throughout the life. Till then, this small handbook, which deals with essential knowledge for day-to-day procedures can help those who want to start intervention as a fellow or an independent operator, as well as the people in Cath Lab, like technicians and nurses who ultimately form the team which delivers necessary care and makes the procedure successful.
I thank my Cath Lab colleagues, who contributed their valuable observations and knowledge, which helped me to write this book.
Shuvanan Ray14
15Acknowledgments
Many people, who have helped directly or indirectly with the production of this book, I am very grateful to them all. If, I have omitted anybody, I offer my sincere apologies.
I wish to humbly acknowledge Susweta Banerjee (Chief of Cath Lab Nursing), Dipankar Sadhukhan, Sujay Bhattacharya, Taslim Ali Khan (Cath Lab Technicians), Jenni, Jijomon, Divya, Jenisha V, John Sheeja Mary, Jisha John, Bala Murugan, Neo Varghese, Rinku Mishra (Cath Lab Nurses), Orpita Nath, Soumi Saha, Kasturi Chakraborty and Banhi Sen (Cath Lab Coordinators) and Snehasis Biswas (for the preparation of entire manuscript), Dr Yashesh Paliwal (ICCU In-Charge), Sister Chandrani Chakraborty, Sister Banani Bhattacharya and Lipika Mondal (Customer Care).
My special acknowledgment to Ms Richa Deb Gupta, The ZD, Fortis Hospitals, Kolkata, West Bengal, India.16