Coronary Angiography and Anatomy Cardiovascular Fellows ...

Coronary Angiography and Anatomy Cardiovascular Fellows ...

Northwestern Memorial Hospital Healthy Transitions Fall Program October 7, 2013 Coronary Artery Disease: Diagnosis and Treatment

Mark J. Ricciardi, MD Director, Interventional Cardiology and Cardiac Catheterization Northwestern Bluhm Cardiovascular Institute Outline

Coronary artery disease (CAD) basics Diagnosis of CAD Cardiac Catheterization / Coronary Angiography

Treatment of CAD Coronary Angioplasty / Stent Past, present, future Coronary Disease Atherosclerosis

Arteriosclerosis Fatty buildup in lining of artery wall Plaque Impinges on flow

Reduces amount of blood and oxygen delivered to the heart muscle Cholesterol deposition Early CAD

Vulnerable Plaque Plaque Rupture Coronary Thrombosis Heart Attack

CAD the goal is prevention Primary prevention Prevent early / sub-clinical stages

Heart healthy lifestyle Starting in childhood Medications Targeted at high risk groups

Diagnosis of CAD History Symptoms Angina

Diagnosis of CAD History Symptoms Angina

Non-invasive imaging Stress testing provocation CT angiogram

good, not great Diagnosis of CAD History Symptoms Angina

Non-invasive imaging Stress testing CT angiogram

Invasive imaging Left heart catheterization / coronary angiography the gold standard for Dx Coronary Angiography Purposes

Define coronary anatomy, and presence, absence, degree obstruction Most commonly used to: determine extent of CAD

assess feasibility and appropriateness of mechanical revascularization Catheterization Catheterization Coronary Angiography

Coronary Angiography Arterial access Femoral artery

Most common access site since 1980s Easy and reliable

Often requires 20-30 minutes of pressure to prevent bleeding - followed by bed-rest 1% risk significant bleeding There are new strategies that hasten recovery time

Bleeding still an issue Arterial access Radial artery

Lower risk of significant bleeding No bed rest required

Arterial access Radial artery Arterial access Radial artery Down side

-the learning curve CAD Treatment CAD Treatment The past

CAD Treatment Secondary prevention Lifestyle modification Diet, exercise, tobacco cessation Rx underlying risk factors

Aspirin and statin medications Anti-anginal medications

Beta blockers Coronary Bypass Coronary Angioplasty Coronary Angioplasty

Coronary Stenting Coronary Stenting Drug Stents Northwestern Memorial Hospital

Cardiac Catheterization Center Chicagolands First: Coronary Stent (1990s) Drug eluting stent (early 2000s) Northwestern Memorial Hospital

Cardiac Catheterization Center Chicagolands First: Coronary Stent (1990s) Drug eluting stent (early 2000s) Bio-absorbable stent (2013)

Next Generation Stents Bioabsorbable / dissolving stents

In clinical trials at Northwestern Conclusions CAD Sub-clinical plaque formation

Symptomatic CAD Angina, heart attack Non-invasive and invasive testing

CAD Treatment Behavioral, pharmacologic, mechanical NW big part of the past, present and future of CAD Rx Questions?

http://watchlearnlive.heart.org/CVML_Player. php?moduleSelect=angiog http://www.scai.org/PatientEducation/default. aspx

Judkins Technique JL and JR catheters Melvin Judkins Cineangiography Angiographic views

Femoral Artery Hemostasis Perclose Suture-Mediated Closure System (Abbott Vascular)

Non-braided polyester suture Automated knot tying Closure of 5-8Fr. access

sites pre-closure Transradial Angiography / Intervention Anatomy No associated major nerve

Median N in carpal tunnel Ulnar N runs with UA Dual arterial supply to hand RA and UA join in 2 arches Superficial and deep palmar arche

Radial Artery Compression Devices The most important bleeding avoidance strategy?

Femoral Radial

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