Best Practices for Transradial Approach in Diagnostic Angiography and Intervention

 

Description:

Best Practices for Transradial Approach in Diagnostic Angiographyand Intervention provides an innovative, patient-friendly approach to percutaneous coronary intervention, delivering authoritative guidance on the procedures, as well as solid evidence from clinical studies and experienced facilities. Learn from pioneers and experts in the field how you can improve patient care and optimize outcomes using this efficient and cost-effective technique. • Increase your knowledge of the tremendous recent advancements to the transradial approach, and learn the clinical advantages and benefits of this approach compared with the standard femoral approach. • Benefit from the combined knowledge of a team of worldwide experts who provide practical "tips and tricks" that help you make the most of this globally acknowledged technique in your practice. • Gain insight into all relevant aspects of transradial coronary access, from basic facts and procedural details to complications and non-coronary interventions. • Examine an up-to-date, in-depth review and critical analysis of data available in the literature. Now with the print edition, enjoy the bundled interactive eBook edition, offering tablet, smartphone, or online access to: •  Dozens of exclusive illustrations that demonstrate the benefits of using the transradial approach in clinical practice. • Complete content with enhanced navigation   • Powerful search tools and smart navigation cross-links that pull results from content in the book, your notes, and even the web • Cross-linked pages, references, and more for easy navigation • Highlighting tool for easier reference of key content throughout the text • Ability to take and share notes with friends and colleagues • Quick reference tabbing to save your favorite content for future use

 

 

Table of Contents:

 

Chapter 1: Historical and Epidemiological Note

Historical and Epidemiological Note

History

The Adoption of Transradial Access in Invasive Cardiology

Conclusion

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Table 1-1: Worldwide Transradial PCI Utilization by Country and Region

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References

Chapter 2: Access Site Bleeding and Nonaccess Site Bleeding

Access Site Bleeding and Nonaccess Site Bleeding

Introduction

Incidence of Bleeding After PCI

Defining Bleeding

Relative Incidence of Access Site and Nonaccess Site Bleeding

Bleeding Complications and Outcomes

Mechanisms

Bleeding Avoidance Strategies and Outcomes

Conclusion

Table 2-1: The Bleeding Academic Research Consortium (BARC) Definition of Bleeding Complications

Figure 2-1

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Table 2-2: Selected Studies Showing an Association between Bleeding Complications and Adverse Outcomes

Table 2-3: Available Bleeding Avoidance Strategies

References

Chapter 3: General Overview, Patient Preparation, and Selection

General Overview, Patient Preparation, and Selection

General Overview

Definition of Transradial Access

Pathophysiologic Rationale for Transradial Access

Clinical Evidence in Support of Transradial Access

Randomized Trials

Meta-analyses

Patient Selection

Radial Artery Selection

Identification of the Artery Pulse

Left or Right Radial Artery?

A Tiny Wrist Does not Necessarily Mean Small Radial Artery

Can Anatomic Variants and Vessel Tortuosity Be Anticipated?

Assessment of Collateral Circulation to the Hand

Patient Preparation

Arm Preparation

Radial Puncture

Spasmolytic Cocktail

Table 3-1: Patient Selection in Key Clinical Trials Focusing on Transradial Access

Table 3-2: Patient Preparation in Key Clinical Trials Focusing on Transradial Access

Table 3-3: Systematic Reviews and Meta-analyses Focusing on Transradial Access

Table 3-4: Practical Hints for Patient Selection for Transradial Access

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References

Chapter 4: Vascularization, Anatomy and Variants

Vascularization, Anatomy and Variants

Arterial Anatomy

Embryology of Forearm Arteries

Embryology of Central Upper Extremity Arteries

Embryology of Peripheral Upper Extremity Arteries

Distal Forearm Artery Anatomy

Loops and Tortuosity

Axillary/Subclavian Region

Venous Anatomy

Introduction

Embryology of the Forearm Veins

Veins Are Different from Arteries

Anatomy of the Forearm Veins

Basilic Vein

Cephalic Vein

Natural Anomalies of the Venous System

Iatrogenic Changes to the Venous System

Breast Cancer Surgery and Lymphedema

Conclusion

Figure 4-1

Figure 4-2

References

Chapter 5: Anatomy, Tortuosities, and Access Difficulties

Anatomy, Tortuosities, and Access Difficulties

Background

Issues Related to Radial and Brachial Regions

Radial Artery Spasm

Tortuosity

Perforation

Loops and Curvatures

Balloon-Assisted Tracking of a Catheter: A Must-Learn Technique

Issues Related to Subclavian, Innominate, and Aortic Arch Regions

Tortuosity in Subclavian Region

Severely Dilated and Distorted Aortic Route (Pseudo-arteria Lusoria)

Conclusion

Acknowledgment

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References

Chapter 6: Radial Artery versus Ulnar Artery Catheterization

Radial Artery versus Ulnar Artery Catheterization

Background

Anatomic Considerations

Allen Tests, Pulse Oximetry, and Doppler Plethysmography

Puncture Technique

Retrograde Arteriography of the Wrist

Postprocedure Management

Potential Benefits of the Transulnar Approach

Limitations of the Transulnar Approach

Entry Site Complications

Conclusion

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Table 6-1: Advantages and Disadvantages of Transulnar Approach

Table 6-2: Potential Indications for Transulnar Access for Cardiovascular Interventions

References

Chapter 7: Tips and Tricks for Diagnostic Angiography and Intervention

Tips and Tricks for Diagnostic Angiography and Intervention

Introduction

Anatomical Considerations

Use of Respiration

Catheter Selection for Diagnostic Coronary Angiography

Catheter Selection for Percutaneous Coronary Interventions

Passive Backup Support Catheters

Prevention of Catheter Kinking and Knotting

Active Backup Support Catheters

Universal Catheters versus Regular Catheters for Percutaneous Coronary Intervention

Saphenous Vein Grafts

Guiding Catheter Extensions

Conclusion

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Table 7-1: Guiding Catheters and Device Compatibility

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Table 7-2: Tips and Tricks to Ensure Successful Transradial Catheterization

References

Chapter 8: Slender Catheters and Techniques

Slender Catheters and Techniques

Introduction

What Is Slender Percutaneous Coronary Intervention?

Device Compatibility in Slender Guiding Catheters

New Devices in Slender Percutaneous Coronary Intervention

Downsizing in Regular 0.014 Inch Balloons

0.010-Inch Guidewire and Compatible Balloon System

Small-Size Intravascular Ultrasound Catheter

New Techniques in Slender Percutaneous Coronary Intervention

Bifurcation Treatment in Slender Percutaneous Coronary Intervention

Chronic Total Occlusion

Distal Protection in Slender Percutaneous Coronary Intervention

Intravascular Ultrasound Catheter in 4F Guiding Catheter

Sheathless System

Virtual 3F/Virtual 2F

Minimum Contrast Technique

Conclusion and Future Perspective

Figure 8-1

Table 8-1: Bifurcation Treatment Technique

Table 8-2: Slender Conversion Table

Table 8-3: New Techniques in Slender PCI

References

Chapter 9: Radial Artery Spasm and Abnormal Flow Reserve

Radial Artery Spasm and Abnormal Flow Reserve

Pathologic Basis of Radial Artery Spasm and Vascular Function

Physiologic Basis of Radial Artery Spasm and Vascular Function

Definition of Radial Artery Spasm

Measurement of Radial Artery Spasm

Mechanism of and Factors Predisposing to Radial Artery Spasm

Impact of Vasodilator Agents on Radial Artery Spasm

Impact of the Introducer Sheath on Radial Artery Spasm

The Potential Effects of Radial Artery Spasm on Other Complications

Predictors of Radial Artery Spasm

Physiologic Changes in the Radial Artery Following Transradial Procedures

The Use of Radial Artery as Graft Conduit and Vascular Function

The Physiologic Basis of Radial Artery Vascular Function and Endothelial Function

Optimization of Vascular Function after Transradial Procedures

Future Directions

Conclusion

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Figure 9-3

References

Chapter 10: Hemostasis and Radial Artery Occlusion

Hemostasis and Radial Artery Occlusion

Introduction

Radial Artery Occlusion: Definition and Incidence

Assessment of Radial Artery Patency

Pathophysiology of Radial Artery Occlusion

Factors Associated with Increased Risk of Radial Artery Occlusion/Predictors of Radial Artery Occlusion

Patient-Related Factors: Gender, Age, Body Mass Index, Peripheral Arterial Occlusive Disease, and Diabetes

Procedural Factors

Duration of Hemostatic Compression

Clinical Sequelae of Radial Artery Occlusion

Ischemia

Treatment of Radial Artery Occlusion: What Is Proven, and What Is Hypothesis-Generating

Pharmacologic Treatment

Nonpharmacologic Treatment

Medicated Sheaths

Sheathless Guides

Conclusion

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Table 10-1: Predictors of RAO

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References

Chapter 11: The Learning Curve for Transradial Coronary Angiography and Intervention

The Learning Curve for Transradial Coronary Angiography and Intervention

Introduction

Clinical Outcomes and the Learning Curve of Transradial Coronary Intervention

The Importance and Challenges of Characterizing Transradial Learning Curve

The Learning Curve of Transradial Coronary Angiography

The Learning Curve of Transradial Coronary Interventions

The Learning Curve of Transradial Angiography and Intervention for Novice Operators

The Implication of Transradial Learning Curve for Training and Competency Guidelines

The Learning Curve of Transradial Angiography and Intervention: Future Research

Conclusion

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Table 11-1: Procedural Outcomes

Figure 11-2

References

Chapter 12: Complications of Transradial Catheterization

Complications of Transradial Catheterization

Introduction

Femoral Artery Access and Complications

Radial Artery Access and Complications

Conclusion

Figure 12-1

Table 12-1: Complete List of Published Vascular Complications with Radial/Ulnar Access

Table 12-2: Comparison of Femoral and Radial Complications

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References

Chapter 13: Right Heart Catheterization Using the Arm: Total Wrist Approach for Diagnosis and Intervention

Right Heart Catheterization Using the Arm: Total Wrist Approach for Diagnosis and Intervention

Introduction

History

Modern Era

Practical Aspects of Venous Catheterization

Vein Physiology

Vasoreactivity

Venous Anatomy of Arm

Localizing Veins

Entering the Venous System

Passage of the Central Venous Catheter or Device

Anatomic Challenges

Practical Suggestions

Finishing the Procedure

Potential Extensions for Peripheral Access to Central Venous System

Conclusion

Table 13-1: Appropriate Use Criteria for Right Heart Catheterization as Defined in 2012a

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Table 13-2: Characteristics of Patients, Procedural Times, and Complications in Those Undergoing Either Femoral or Radial Right and Left Heart Catheterization

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References

Chapter 14: Coronary Interventions: 5F versus 6F to 7F

Coronary Interventions: 5F versus 6F to 7F

Introduction

Size of the Radial Artery and Artery Diameter/Sheath Size Ratio

Backup Support and Vascular Tortuosity

5F versus 6F Guiding Catheters for Coronary Intervention

The Slender Catheters for Percutaneous Intervention

Bifurcational Lesions

Debulking Procedures

Chronic Total Occlusion

Feasibility of 7F Radial Approach for Complex Percutaneous Coronary Interventions

Conclusion

Table 14-1: Guiding Catheters for Coronary Intervention

References

Chapter 15: Primary and Rescue Percutaneous Coronary Intervention

Primary and Rescue Percutaneous Coronary Intervention

Introduction

Importance of Bleeding

Access Site versus Non–access Site Bleeding

Time Is Important in ST-Elevation Myocardial Infarction

Potential Advantages of Radial Access in ST-Elevation Myocardial Infarction

Potential Disadvantages of Radial Access in ST-Elevation Myocardial Infarction

Evidence Regarding the Use of Radial versus Femoral Access in ST-Elevation Myocardial Infarction

Guidelines

Growth in the Use of Radial Access during Primary Percutaneous Coronary Intervention

Recommendations

Conclusion

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Table 15-1: Characteristics of Randomized Trials of Radial versus Femoral Access

Table 15-2: Event Rates in Randomized Trials of Radial versus Femoral Access

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References

Chapter 16: Transradial Approach for Diagnostic and Interventional Procedures in Patients with Coronary Bypass Grafts

Transradial Approach for Diagnostic and Interventional Procedures in Patients with Coronary Bypass Grafts

Introduction

Procedure Planning

History Evaluation

Radial Artery Evaluation

In Situ Internal Mammary Artery Grafts

Homolateral Transradial Approach in Patients with Internal Mammary Graft

Contralateral Transradial Approach in Patients with Internal Mammary Graft

Aorto-coronary Grafts

Transradial Approach in Patients with Saphenous Vein Grafts

Radial Artery Grafts and Grafts Rising from Descending Aorta

Conclusion

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Table 16-1: Compatibility between Guiding Catheter and Antiembolic Devices in Percutaneous Interventions on Degenerated SVGs

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References

Chapter 17: Radial and Complex Coronary Interventions: Chronic Occlusion

Radial and Complex Coronary Interventions: Chronic Occlusion

PCI of CTOs: Techniques, Strategies, and Devices

Specific Issues of Transradial PCI for CTO

Transradial PCI Treatment of CTO: Experience and Results

Conclusion

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Table 17-1: Compatibility of Materials and Techniques with 5F to 8F Guiding Catheters and Sheath Size in a French Population

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Table 17-2: Comparison of the Transradial and the Transfemoral Approaches in CTO PCI

Table 17-3: Nonrandomized Comparison of Radial and Femoral Approaches in ICPS CTO Database

References

Chapter 18: Radial Approach and Complex Coronary Interventions: Bifurcations

Radial Approach and Complex Coronary Interventions: Bifurcations

Introduction

Adaptation of Bifurcation Techniques to the Transradial Approach

The Single-Stent or Provisional Approach

The Culotte Technique

The Crush Technique Modifications

T-stenting Techniques

Stent/Simultaneous Kissing Stent Techniques

Conclusion

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References

Chapter 19: Transradial Percutaneous Revascularization for Unprotected Left Main Coronary Artery Disease: An Evolution in Evidence and Technique

Transradial Percutaneous Revascularization for Unprotected Left Main Coronary Artery Disease: An Evolution in Evidence and Technique

Introduction

Contemporary Trials in ULM Percutaneous Revascularization

Procedural Strategy and Technique

Transradial ULM Percutaneous Revascularization

Conclusion

Table 19-1: Transradial versus Transfemoral Unprotected Left Main Percutaneous Revascularization Procedural, In-hospital, and Late Outcomes

Figure 19-1

References

Chapter 20: Sheathless Guide Catheters

Sheathless Guide Catheters

Background

Radial Artery Size

Asahi Sheathless Eaucath

Medikit “Virtual” 3F Percutaneous Coronary Intervention

Alternative Systems

Conclusion

Figure 20-1

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Table 20-1: Proportion of Patients in Whom the Radial Lumen Is Less Than the Diameter of Conventional 4F, 5F, 6F, and 7F Sheaths

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Figure 20-9

References

Chapter 21: Radial Approach in the Elderly

Radial Approach in the Elderly

Outcomes After Percutaneous Coronary Intervention for Elderly Patients versus Younger Patients

Elective Percutaneous Coronary Intervention

Percutaneous Coronary Intervention for Acute Coronary Syndromes

Radial Access in Elderly Patients versus Younger Patients

Radial Artery Size

Tortuosity and Calcification

Right versus Left Radial Access

Radial versus Femoral Access in Elderly Patients

Observational Studies

Randomized Trials

Use of Radial Access for Elderly Patients in Clinical Practice

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Table 21-1: Trends and Outcomes of PCI in Elderly Patients: Elective, ACS, and STEMI

Table 21-2: Studies of Radial versus Femoral Access in Elderly Patients

Figure 21-2

References

Chapter 22: Carotid, Femoral, Aortoiliac, and Renal Interventions

Carotid, Femoral, Aortoiliac, and Renal Interventions

Transradial Carotid Stenting

Introduction

Transradial Carotid Angiography

Right Radial Access for Carotid Stenting

Right Internal Carotid

Nonbovine Left Internal Carotid

Bovine Left Internal Carotid

Caveats

Conclusion

Aorto-Iliac

Natural History

Clinical Diagnosis and Vascular Testing

Treatment

Conclusion

Transradial Femoral Intervention

Renal Artery Intervention

Access-Site Choice

Advantages of Radial Approach

Transradial Renal Angiography and Interventional Techniques

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Table 22-1: Classification of Peripheral Arterial Disease: Fontaine’s Stages and Rutherford’s Categories

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References

Chapter 23: Radiation in Transradial Access

Radiation in Transradial Access

Introduction

Adverse Effects of Radiation

Deterministic Effects

Stochastic Effects

Radiation Doses

Factors Affecting Patient and Operator Doses

Patient Factors

Operational Factors

Radiation in Transradial versus Transfemoral Studies

Observational Studies

Randomized Studies

Emerging Concepts

Which Wrist?

More Shields?

Fluoroscopic Frame Rate

Conclusion

Acknowledgment

Table 23-1: Quantification of Radiation Delivery

Table 23-2: Typical ED Estimates for Various X-ray Procedures

Table 23-3: Proposed Dose Reference Levels for Diagnostic Coronary Angiography (CA) and Percutaneous Coronary Intervention (PCI)

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References

Chapter 24: The Radial Approach and the Risk of Periprocedural Stroke

The Radial Approach and the Risk of Periprocedural Stroke

Why Are We Talking About It?

From Where Do These Fears Originate?

How Should We Investigate This Further?

The Mechanisms of Periprocedural Stroke

Studies Using Surrogate Markers

Contemporary Registry Data

Data from Randomized Controlled Trials

Conclusion—What Is Known and Not Known

Table 24-1: Results of All 30 Swedish Centers Performing Angiography and PCI, 2000 to 2004, from the SCAAR

Table 24-2: Incidence of Stroke in Major PCI Registries

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References

Chapter 25: Nursing Workload

Nursing Workload

Introduction

Preprocedural Nursing

Patient Selection for TRA and Same-Day Discharge

Patient Education/Preparation

Procedural Nursing

Postprocedural Nursing

Follow-up Nursing

Patient Satisfaction

Conclusion

Table 25-1: Procedural Durations

Table 25-2: Staff Workload

Table 25-3: Economic Impact of Staff Involvement

Table 25-4: Ward NWL According to Clinical, Procedural, In-hospital Variables, and Arterial Access

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References

Chapter 26: Quality of Life and Cost-Effectiveness

Quality of Life and Cost-Effectiveness

Introduction

Organization of This Chapter

Importance of Quality-of-Life Measures

QOL and Cardiac Catheterization: Clinical Data

Ambulatory Percutaneous Coronary Intervention

Cost of Complications

Cost of Clinical Staff Workload

Length of Stay

TR versus TF Access: Economic Substudies of Clinical Trials

Diagnostic Catheterization

TR-PCI

Ambulatory PCI Procedures

Conclusion

Table 26-1: Resource Use by Bleeding Severity

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References

Chapter 27: Transradial Approach in Structural Heart Disease

Transradial Approach in Structural Heart Disease

Transradial Catheterization during Mitral Valve Procedures

Transradial Catheterization during Aortic Valve Procedures

Transradial Catheterization during Alcohol Septal Ablation

Transradial Catheterization during Procedures for Coarctation of Aorta

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Figure 27-2

References

Chapter 28: Randomized Studies of Transradial versus Transfemoral Coronary Approach

Randomized Studies of Transradial versus Transfemoral Coronary Approach

Abbreviations

Right Radial Access for PTCA: A Prospective Study Demonstrates Reduced Complications and Hospital Charges

Access

Brafe Stent

Stenting in Acute Coronary Syndromes: A Comparison of Radial versus Femoral Access Sites

Effect of Transradial Access on Quality of Life and Cost of Cardiac Catheterization: A Randomized Comparison

CARAFE

TEMPURA

OCTOPLUS

OUTCLAS

RADIAL-AMI

Randomized Comparison of Operator Radiation Exposure during Coronary Angiography and Intervention by Radial and Femoral Approaches

Safety and Feasibility of Emergent Percutaneous Coronary Intervention with the Transradial Access in Patients with Acute Myocardial Infarction

FARMI

Transradial versus Transfemoral Approach for Coronary Angiography and Intervention in Patients Older Than 75 years

The Left Radial Approach in Daily Practice: A Randomized Study Comparing Femoral and Right and Left Radial Approaches

RADIAMI

A Randomized Comparison of Transradial versus Transfemoral Approach for Coronary Angiography and Angioplasty

Comparative Study on Transradial versus Transfemoral Approach for Primary Percutaneous Coronary Intervention in Chinese Patients with Acute Myocardial Infarction

TALENT

Randomized Comparison of Transradial Coronary Angiography via Right or Left Radial Artery Approaches

RADIAMI II

A Randomized Study Comparing the Effectiveness of Right and Left Radial Approaches for Coronary Angiography

RIVAL

Impact of Transradial and Transfemoral Coronary Interventions on Bleeding and Net Adverse Clinical Events in Acute Coronary Syndromes

RIFLE-STEACS

Randomized Comparison of Radial versus Femoral Approach in Patients with STEMI Undergoing Early PCI Following Intravenous Thrombolysis

OPERA

AURA

STEMI-RADIAL

Comparison of Pain Levels of Transradial versus Transfemoral Coronary Catheterization: A Prospective and Randomized Study

A Randomized Trial of 5- versus 6F TRA Coronary Interventions

Novel Diagnostic Catheter Specifically Designed for Both Coronary Arteries via the Right Transradial Approach: A Prospective, Randomized Trial of Tiger II versus Judkins Catheters

A 5F Catheter Approach Reduces Patient Discomfort during Transradial Coronary Intervention Compared with a 6F Approach: A Prospective Randomized Study

Impact of Length and Hydrophilic Coating of the Introducer Sheath on Radial Artery Spasm during Transradial Coronary Intervention: A Randomized Study

EASY

PROPHET

EASY—COSTS

A Comparison of Two Devices for Radial Artery Hemostasis after Transradial Coronary Intervention

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Chapter 29: Conclusions and Future Directions

Conclusions and Future Directions

Appendix

Remarks

 

An aparitie	5 Feb. 2015
Autor	Olivier Bertrand, Sunil Rao
Dimensiuni	17.78 x 2.54 x 25.4 cm
Editura	LWW
Format	Hardcover
ISBN	9781451177251
Limba	Engleza
Nr pag	350