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NIC Companion Book of Interventional Cardiology
Rishi Sethi, Narendra Nath Khanna, J Shiv Kumar
1 CHAPTER:
Good Clinical Practices in Cath Lab
INTRODUCTION
THE TEAM APPROACH
COMMUNICATION: ENCOURAGE THE CULTURE TO SPEAK-UP
Before the Table
Indications and Examination
Informed Consent
Checklist
Sedation and Anxiolytics
Diabetic Patient
Never Forget to Calculate the Risk
On the Table
Time Out
Patient Preparation and Access
Radiation Safety
Universal Precautions
Sharp Protection
Attention to Infection
Look Out for CIN
After the Table
Final Communication
Access Site Management
Postprocedure Instructions
CONCLUSION
2 CHAPTER:
Ten Commandments of Radial Interventions
INTRODUCTION
COMMANDMENT 1: PATIENT SELECTION, PREPARATION AND CATH LAB SET-UP CRITERIA
COMMANDMENT 2: GAINING RADIAL ARTERY ACCESS
COMMANDMENT 3: MANAGEMENT OF RA SPASM
COMMANDMENT 4: AIMING AT REDUCTION OF RADIAL ARTERY OCCLUSION
COMMANDMENT 5: WORKING THROUGH COMPLEXITIES OF RADIAL AND BRACHIAL VASCULATURE
Tools and Techniques Useful to Overcoming RA and BA Anatomical Challenges
COMMANDMENT 6: WORKING THROUGH CHALLENGES OF SUBCLAVIAN INNOMINATE AND AORTIC ARCH REGIONS
Tools and Techniques Useful to Overcoming Subclavian, Innominate and Aortic Arch Challenges
COMMANDMENT 7: CATHETER SELECTION CRITERIA
General Considerations for Choice of Catheter Shapes in TRA
General Considerations for Choosing Catheter Size for TRA
General Considerations for Choice of Catheters for Bypass Graft Cannulation
COMMANDMENT 8: POST-PROCEDURE MANAGEMENT
COMMANDMENT 9: MANAGEMENT OF COMPLICATIONS
Perforation
Hematoma
Compartment Syndrome
Other Radial Complications
COMMANDMENT 10: DEALING WITH SPECIAL SITUATIONS
Left versus Right TRA
TRA and Primary PCI
TRA for Chronic Total Occlusions
TRA for LMCA Lesions
TRA for Peripheral Vascular Interventions
CONCLUSION
ACKNOWLEDGMENT
3 CHAPTER:
Fractional Flow Reserve: How to Interpret in Different Situations?
INTRODUCTION
PRINCIPLES OF CORONARY PRESSURE AND FLOW
Measurement of fractional flow reserve
Derivation of Fractional Flow Reserve
INDUCTION OF MAXIMAL HYPEREMIA
Adenosine
Papaverine
SPECIFIC FEATURES AND LIMITATIONS OF FRACTIONAL FLOW RESERVE
METHODOLOGY FOR ASSESSMENT OF FRACTIONAL FLOW RESERVE
Validation and Cut-off Threshold for Fractional Flow Reserve
Usefulness of Fractional Flow Reserve in Clinical Practice
Intermediate Stenosis (Figs 3.6 to 3.8)
Multivessel Disease
Fractional Flow Reserve in Diffuse Epicardial Disease
Fractional Flow Reserve in Serial Epicardial Stenosis (Fig. 3.11)
Fractional Flow Reserve in Ostial Stenosis (Figs 3.7 and 3.8)
Recent Myocardial Infarction
ECONOMIC CONSIDERATIONS AND PHYSIOLOGICALLY-GUIDED REVASCULARIZATION
SUMMARY
4 CHAPTER:
Uses of Optical Coherence Tomography in Special Situations
INTRODUCTION
PREPROCEDURAL LESION ASSESSMENT
Intraluminal Filling Defects
Spontaneous Coronary Artery Dissection
Angiographic Haziness
Bifurcation Lesions
During Percutaneous Coronary Interventions
Postpercutaneous Coronary Interventions Assessment
Suboptimal Angiographic Result
Assessment of Bioresorbable Vascular Scaffold
In Stent Restenosis
Stent Thrombosis
Need for Long-term Dual Antiplatelet Therapy
MISCELLANEOUS
CONCLUSION
5 CHAPTER:
Antegrade Approach to Chronic Total Occlusion
INTRODUCTION
THE BASICS: PREPARE FOR SUCCESS
VASCULAR ACCESS AND GUIDE SUPPORT
PROCEDURAL ANTICOAGULATION
Approach to the Chronic Total Occlusion
ANTEGRADE WIRE
Step-by-Step Details
ANTEGRADE DISSECTION/RE-ENTRY
DEDICATED RE-ENTRY SYSTEMS
Step-by-Step Details
Getting into the Chronic Total Occlusion
Subintimal Crossing: Knuckle Wire vs CrossBoss
CrossBoss Catheter
TIPS AND TRICKS
Problem Solving
Re-entry into Distal True Lumen
Stingray-based Re-entry
Preparation of the Stingray Balloon
Delivery of the Stingray Balloon to the Re-entry Zone (Fig. 5.11)
Re-entry into the Distal True Lumen
Exchange for a Workhorse Wire
Potential Problems
FINAL THOUGHTS
6 CHAPTER:
Retrograde Approach to Chronic Total Occlusion
TYPES OF RETROGRADE TECHNIQUES
WHAT DO YOU NEED FOR RETROGRADE CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION
Access
Hardware
Stepwise Approach to Retrograde
Features Required for CTO Wires
How to Progress in Retrograde Procedure?
ADDITIONAL TOOLS
Guideliner/Guidezilla
Complications
KEY POINTS
7 CHAPTER:
Technique and Role of Rotablation in Interventional Cardiology
INTRODUCTION
PRINCIPLE OF ROTABLATION
MECHANISM OF ACTION
Porcine Model
Intravascular Ultrasound Image
Components of Rotablator System
Rotawire Floppy Guidewire (Fig. 7.10)
Rotawire Extrasupport Guidewire
Disposable Components Overview
Burr (Fig. 7.12)
WireClip Torquer (Fig. 7.13)
RotaLink Catheter Connection (Fig. 7.14)
INDICATIONS
CONTRAINDICATIONS
Precautions
PROCEDURE
Guide Catheter Selection
Burr Selection and Treatment Strategies
Guidewire Selection
PROCEDURAL INFORMATION
DRAW: Preprocedure Test
Burr Positioning (Physician Considerations)
Burr Speed
Burr Movement (Physician Considerations)
Feedback During Ablation
Tactile
Visual
Auditory
Ablation Procedure Tips (Physician Considerations)
Important Reminder on the Y-Connector
The Directions for Use for the RotablatorTM
LESION-SPECIFIC INDICATIONS
Calcified Lesions
Chronic Total Occlusions
Aorto-ostial Right Coronary Lesions, Left Main and Branch Ostial Lesions
Bifurcation Lesions
In-stent Restenosis
Debulking before Stents or Undilatable Lesions/Unexpanded Stents
Stent Jail
COMPLICATIONS
Vasospasm
Slow Flow or no Reflow
Perforations
Bradycardia and Atrioventricular Block
Dissections
ROTABLATOR SYSTEM FAILURE
Burr Detachment
BURR ENTRAPMENT
Management of Stuck Rotablator
PREVENTION OF ENTRAPMENT
8 CHAPTER:
Bifurcation Coronary Lesions: Definition, Classification, and Approaches to Bifurcation Management
INTRODUCTION
ANATOMICAL AND HEMODYNAMIC SPECIFICATIONS OF BIFURCATION SEGMENTS11
APPROACH TO BIFURCATION TREATMENT21
Provisional Approach
Provisional Stenting Technique Description21
A SECOND STENT IN THE SIDE BRANCH FOLLOWING PROVISIONAL APPROACH21
Two Stents as an “Intention to Treat”21
INVERTED CULOTTE TECHNIQUE21
MINI-CRUSH TECHNIQUE21
V and the Simultaneous Kissing Stent Techniques21
DEDICATED BIFURCATION STENTS
CONCLUSION
CHAPTER 9:
Tips and Tricks of Vein Graft Intervention
Natural history of Saphenous Vein Graft disease
INDICATIONS
Access Site and Guide Catheter Selection
Pharmacologic and Mechanical Strategies during SVG-PCI
COVERED STENTS
DES Vs BMS
CONCLUSION
CHAPTER 10:
Step by Step and Challenging Situations in Patent Ductus Arteriosus Closure
History of transcatheter closure of Patent Ductus Arteriosus
CURRENT INDICATIONS
CONTRAINDICATIONS
PATIENT SELECTION
ROLE OF ECHOCARDIOGRAPHY
Angiographic delineation of Patent Ductus Arteriosus
Limitations of angiographic classification
STEP BY STEP PROCEDURE
SPECIAL SUBSETS
Preemies
Patent Ductus Arteriosus with Severe Pulmonary Hypertension
Long and Large Ducts in Infancy
CONCLUDING REMARKS
CHAPTER 11:
Step-by-Step Ventricular Septal Defect-Device Closure
INTRODUCTION
PATIENT SELECTION
Type and Location of VSD
Hemodynamic Significance
Contraindication
DEVICES SELECTION (TABLE 11.1)
Devices for Closure of Muscular VSD
Devices for Closure of Perimembranous Device
Hardware Required in Cath Lab
Technique of device closure of VSD (Figs 11.2 and 11.3)
Access
Approach
Angiography View
Device Sizing
Choice of Device (Table 11.1)
Device Closure of Postinfarct VSD
COMPLICATIONS
Major Complications
Minor Complications
Patient Follow-up
SUMMARY
CHAPTER 12:
Endovascular Repair of Aortic Aneurysm
BACKGROUND
WHY SHOULD INTERVENTIONAL CARDIOLOGISTS DO ENDOVASCULAR ANEURYSM REPAIR?
AORTIC ANEURYSMS
Etiology and Pathogenesis
Natural History
Clinical Manifestations
Management
ENDOVASCULAR AORTIC ANEURYSM REPAIR
Imaging
Case Selection
Planning of Procedure
Vascular Access
Access
Percutaneous Access (pEVAR)
Steps of Device Deployment
Contralateral Gate Access
Contralateral Limb
Role of Intravascular Ultrasound
Endograft Surveillance
Endoleak
Ruptured Aneurysm
Recent Advances in EVAR
Fenestrated Endografts
Chimney Grafts
Nellix Endovascular Aneurysm Sealing System
Cardiatis Multilayer Flow Modulator
CONCLUSION
Thoracic Endovascular Aortic Repair
Genomics, Proteomics and Cellular Therapy in Aortic Aneurysms
CHAPTER 13:
Use of Positron Emission Tomography in Cardiology
INTRODUCTION
Positron emission tomography Perfusion tracers
Mode of Stress
Image Acquisition Protocol for Perfusion Imaging
Prognostic Role of PET-MPI
Coronary Flow Reserve
Role of PET-MPI in Treatment Strategies
Cardiac PET Viability Imaging
CONCLUSION
CHAPTER 14:
Cardiogenic Shock
REVASCULARIZATION
MECHANICAL SUPPORT
Intra-aortic Balloon Pump
Left Ventricular-Assist Devices
Left Ventricle to Aorta-assist Devices
Left Atrial to Aorta-assist Devices
Extracorporeal Membrane Oxygenation
CONCLUSION
CHAPTER 15:
Carotid Angioplasty and Stenting: State-of-the-Art
INTRODUCTION
INDICATIONS
KEY STEPS IN CAROTID ARTERY STENTING
Registries—Randomized Studies: Results
Registries Randomized Studies—Practical Consequences
CONCLUSION
CHAPTER 16:
Tips and Tricks of Central Vein Recanalization
INTRODUCTION
ENDOVASCULAR INTERVENTION
TECHNICAL KEY POINTS FOR INTERVENTION
CASE SCENARIOS
Case 1
CASE 2: Sharp Recanalization Using Brockenbrough Needle
CONCLUSION
CHAPTER 17:
Pressure Wire…Beyond Fractional Flow Reserve
INTRODUCTION
PHYSIOLOGICAL BASIS OF INSTANT WAVE-FREE RATIO
HOW TO MEASURE instant wave-free ratio
INSTANT WAVE-FREE RATIO COMPARED TO FRACTIONAL FLOW RESERVE
IMPLEMENTATION OF INSTANT WAVE-FREE RATIO INTO CLINICAL PRACTICE
INSTANT WAVE-FREE RATIO IN TANDEM LESIONS AND VIRTUAL STENTING
CONCLUSION
CHAPTER 18:
Retrieval of Foreign Bodies during Cardiac Catheterization
INTRODUCTION
Long and Skinny
Round and Slippery
BACKGROUND
RETRIEVAL DEVICES
Prerequisites to Attempting the Retrieval
METHODS
CONCLUSION
CHAPTER 19:
Aortic and Pulmonary Balloon Valvotomy: A Step-by-Step Guide
INTRODUCTION
Timing of intervention for aortic stenosis
Aortic Stenosis Subvalvular (Discrete Membrane)/Supravalvular (Discrete)
TECHNIQUE
PROCEDURE
Retrograde Technique
Antegrade Approach
POST-CATHETERIZATION CARE
COMPLICATIONS AND RESULTS
Balloon pulmonary valvuloplasty
Introduction
Indication of Intervention in Pulmonary Stenosis
Choice
Pre-catheterization Work-up
Chest X-ray and Echocardiogram
Sedation
Hemodynamic Measurements
Procedure and Technique
Caution
Post-procedure Care
Complications
Prognosis
CHAPTER 20:
Step-by-Step Approach to Transcatheter Aortic Valve Implantation
Indications for percutaneous treatment
Planning and Patient Assessment
Complications Transcatheter Aortic Valve Implantation/Transcatheter Aortic Valve Replacement
FINAL THOUGHT
INDEX
TOC
Index
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