Practical Manual of Interventional Cardiology

✍ Scribed by Annapoorna Kini (editor), Samin K. Sharma (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 448
• Edition: 2nd ed. 2021
• Category: Library

✦ Synopsis

The second edition of this essential book provides a practically applicable manual to a variety of procedures in interventional cardiology keeping up to date with the advancements in percutaneous interventions. All included chapters identify areas that have significantly developed, and feature step-by-step user guides for the latest cardiac intervention techniques for the treatment of various conditions and the use of devices. Many new tops have been discussed such as left main coronary interventions and how to use Cangrelor in patients requiring P2Y12 inhibition after surgery. New topics covered include how to select patients for transcatheter aortic valve replacement (TAVR), and appropriately apply in-stent restenosis methodologies.

 

Practical Manual of Interventional Cardiology systematically describes the use of a range of simple and complex interventional cardiology procedures, and the challenges associated with utilizing these techniques. It is therefore ideal for use by practicing and trainee cardiologists seeking an easily accessible reference to apply in their everyday clinical practice.

✦ Table of Contents

Contents
Part I: Interventional Basics
1: Basics of Radiation Safety
Introduction
Biological Effects
Regulatory Recommendations
ALARA
Radiation Units and Dose Monitoring
Safety Components
Radiation Monitoring
Shielding
Procedural Issues
Precautions to Minimize Operator Exposure
Precautions to Minimize Patient Exposure
Impact on Patient Care
References
2: Vascular Access
Introduction
Femoral Access
Contraindications for Femoral Artery Access
Sheath Selection
Needle Used
Ideal Access Location
Common Steps for Micropuncture and Regular Access Needle
18-gauge Needle Steps
Micropuncture Steps
Angiographic Views
Complications
Radial Access
TRA Failure
Advantages and Limitations of TRA for Cardiac Procedures
Vascular Anatomy of the Hand
Patient Screening and Selection
Contraindications for Radial Access
Preprocedural Testing
Allen’s Test
Barbeau’s Test (Allen’s Oximetry Test)
Prepping the Arm
Radial Artery Puncture and Sheath Insertion
Antithrombotic Agents
Vasodilators Agents
Radial Complications
Radial Artery Spasm
Radial Artery Occlusion
Access Site Hematoma
Forearm Hematoma
Pseudoaneurysm Formation
Radial Artery Tortuosity or Loop
Radial Artery Stenosis
Other Rare Complications
References
3: Coronary Anatomy and Angiography
Introduction
Coronary Anatomy and Segment Classification
Imaging Basics
Image Orientation
Image Projections
Our Protocol for Coronary Angiography
Left Coronary System
Right Coronary System
Defining Specific Lesions
Left Ventricle Angiography
Setup
LV Imaging
Quantification of Aortic and Mitral Regurgitation (Table 3.2)
Angiography Interpretation
Degree of Tortuosity (Fig. 3.5)
Characteristic of ACC/AHA Type A, B, and C Lesions (Table 3.4)
Bifurcation Lesions Classified Based on Medina Classification
References
4: Physiological Assessment During Interventional Procedures
Introduction
Coronary Flow Reserve (CFR)
Fractional Flow Reserve (FFR)
Special Characteristics of FFR
Value of FFR
Summary of Major FFR Trials (Table 4.1)
Drugs Used
Role of FFR
Steps of FFR
FFR of Multiple Lesions in the Same Vessel
FFR in Left Main Disease
FFR in SVG Disease
FFR in Acute MI
FFR in in-Stent Restenosis
FFR Troubleshooting
Instantaneous Wave-Free Ratio
iFR Development
Summary of Major iFR Trials (Table 4.2)
Steps of iFR
iFR Co-registration and Angiography to Guide Coronary Interventions (Fig. 4.6)
Ct-FFR (FFRCT)
CT-FFR Development
Summary of Major CT-FFR Trials (Table 4.3)
References
5: Antiplatelet and Antithrombotic Therapy in Percutaneous Coronary Interventions
Introduction
Oral Antiplatelet Therapy
Aspirin: All Patients
Dual Antiplatelet Therapy
P2Y12 Antagonist Therapy
Parenteral P2Y12 Inhibitor – Cangrelor [2, 3]
Special Considerations
Duration and Switching of DAPT
Antiplatelet Therapy in PCI Patients Requiring Oral Anticoagulation
Anticoagulation for PCI
Elective Non-cardiac Surgery after PCI [5]
Role of Glycoprotein (GP) IIb/IIIa Inhibitors [13]
Managing Thrombocytopenia Post-PCI
Platelets <20 K
Platelets 20–50 K
Platelets 50–100 K
Future Directions
References
6: Patient Selection and Appropriate Use Criteria
Introduction
Appropriate Use Criteria for Stable Ischemic Heart Disease
Appropriate Use Criteria for Acute Coronary Syndrome
References
7: Guide Catheter Selection
Introduction
Guide Catheters
Guiding Catheter Layers
Guide Selection
Step One: Side Holes
Step Two: French Size
Step Three: Guide Length
Step Four: Guide Catheter Support
Pearls
Step Five: Catheter Curve
Step Six: Knowledge of Vascular Anatomy/Ostial Origin of Coronary Arteries
Coronary Ostial Origin and Orientation
Classification of Coronary Ostial Origin and Orientation
Catheter Selection for Anomalous Right Coronary Artery
Anomalous RCA Catheter Selection
Different Guide Catheters Available
Types of Guide Catheters
Pearls
8: Guidewire Properties and Selection
Introduction
Structure of the Guidewire
Core
Tip
Surface Coating
Classification of Guidewires
Selection of Guidewires
Guidewires for Standard Lesion Morphology
Guidewires for Chronic Total Occlusions
Technical Tips
Guidewire Manipulation
Shaping the Wire Tip
Steering
Wiring the Left Anterior Descending Artery (LAD)
Wiring the Left Circumflex Artery (LCx)
Wiring the Right Coronary Artery (RCA)
Better Torque Control
Pearl
Wire Prolapsing
Advancing a Wire Through Severely Angulated Segment by Pulling It Back
Directing the Wire When Navigating the LAD
Crossing a Stent
9: Fundamentals of Intracoronary Imaging
Introduction
Intravascular Ultrasound (IVUS)
Principle of IVUS Imaging
Indications
Image Characteristics
Image Acquisition
Practical Considerations
Limitations
Image Characteristic
Optical Coherence Tomography (OCT)
Principles of OCT Imaging
Indications
Image Characteristics
Image Acquisition
Equipment and Practical Aspects
Limitations
Image Characteristics
Comparing OCT vs IVUS
Near-Infrared Spectroscopy (NIRS): Intravascular Ultrasound (IVUS) Imaging
How It Works
Equipment
Indications
Limitations
NIRS–IVUS Numbers to Remember
References
10: Basics of Intracoronary Devices
Introduction
Balloons
Compliant/Semi-Compliant Balloon
Noncompliant Balloon
Cutting Balloon (Wolverine™ Flextome™)
Scoring Balloon (AngioSculpt™)
Chocolate XD® PTCA Balloon Catheter
Super High-Pressure Balloon (OPN NC)
Coronary Stents
Components of Stent
Guide Catheter Extension
Prototypes
Components
Use
Technical Tips
Thrombus Aspiration Catheter
Use
Types
Pronto™
AngioJet™
Penumbra Indigo System with CAT RX Aspiration Catheter
Rotational/Orbital Atherectomy/Laser/Lithoplasty System (Shock-Wave™)
Covered Stents
JOSTENT GraftMaster™
PK Papyrus™ Covered Coronary Stent
Embolic Protection Devices (EPD)
Types (Fig. 10.9)
PercuSurge GuardWire™
SpiderFx™ Filter
FilterWire EZ System™
Intravascular Brachytherapy (IVBT)
IVBT
Novoste Beta-Cath™
Microcatheters for Standard Use
Corsair Catheter™
Twin-Pass™ Catheter (the Only Dual-Lumen Microcatheter Available in the US)
Microcatheters for Difficult Wiring of Side Branches or Angulated Lesions
Venture™ Catheter
SuperCross™ Catheter
SwiftNINJA™ Catheter
Microcatheters for Further Support by Anchoring
Microcatheters: For Anchoring Support
Microcatheters: CTO Catheters
CROSSBOSS™ Coronary CTO Crossing Catheter
Stingray™ Coronary CTO Re-Entry System
Snares
Prototypes
Use
11: Hemodynamic Assessment: Right Heart Catheterization, Pulmonary Hypertension, Left-to-Right Shunt, Constriction, and Restriction
Introduction
Right Heart Catheterization
Indications [1]
Contraindications and Cautions [1]
Equipment
Access
Fluoroscopic Views
Steps for Standard Right Heart Catheterization
Troubleshooting
Understanding Standard and Normal Right Heart Pressure Tracings (Table 11.1)
Steps for Evaluation of Pulmonary Hypertension
Steps for Evaluation of Left-to-Right Shunt
Steps for Evaluation of Constriction Versus Restriction
Case Depiction of Constrictive Pericarditis Physiology by Cardiac Catheterization
Complications
Post-Procedural Care
References
12: Hemodynamic Assessment of Valvular Stenosis and Regurgitation
Introduction
Aortic Stenosis
Indications
Contraindications
Equipment
Access
Fluoroscopic Views
Hemodynamics Findings
Steps
Complications
Post-Procedure Care
Mitral Stenosis
Indications
Contraindications
Equipment
Access
Fluoroscopic Views
Hemodynamic Findings
Steps by Step Approach
Complications
Post-Procedure Care
Mitral and Aortic Regurgitation
Indications
Contraindications
Equipment
Access
Hemodynamics Findings
Fluoroscopic Views
Steps for Aortography
Steps for Left Ventriculography
Quantification of Regurgitation (MR or AI)
Complications
Post-Procedure Care
References
13: Vascular Closure Devices and Complications
Introduction
Perclose™ (Abbott Vascular, Abbott Park, IL): Suture-Based Device
Indications
Contraindications
Deployment Steps
StarClose SE™ (Abbott Vascular, Abbott Park, IL): Nitinol Clip
Indications
Contraindications
Deployment Steps
Angio-Seal™ (St. Jude Medical): Collagen Plug Device
Indications
Contraindications
Deployment Steps
MANTA™ Vascular Closure Device (Teleflex): Collagen-based
Indications
Contraindications
Deployment Steps
VASCADE® (CARDIVA Medical Inc.): Resorbable Extra-Vascular Collagen Patch
Indications
Contraindications
Deployment Steps
MynxGrip™ (AccessClosure, Santa Clara, CA): Polyethylene Glycol Plug Device
Indications
Contraindications
Deployment Steps
Transradial Band™ (Terumo Interventional Systems, Somerset, NJ): Non-occlusive Radial External Hemostasis Device
Indications
Deployment Steps
FemoStop™ Mechanical External Compression Device (St. Jude Medical, St. Paul, MN)
Indications
Contraindications
Deployment Steps
References
Part II: Coronary Intervention
14: Basics of Intervention
Introduction
Preprocedural Components
History
Focused Physical Examination
Prior Studies
Informed Consent
Contraindications
Preprocedural Preparation
Periprocedural Components
Vitals
Medications
Postprocedural Management and Care
Bed Rest
Fluids
Labs
Imaging
Disposition After the Procedure
Post-PTCA Pharmacology
References
15: Difficult Stent Delivery
Introduction
Characteristics Associated with Stent Delivery Failure
Steps to Help Prevent Difficulties in Stent Delivery
Long Sheath
Appropriate Guide Selection
Adequate Lesion Preparation
Stepwise Approach to Facilitate Stent Delivery
Deep Seating Guide [1, 2]
Deep Inspiration [3, 4]
Changing Wire
Buddy Wire
Guide Support Extension Catheters
Change Stent Length
Buddy Balloon [8]
Buddy-in-Jail Wire Technique [9]
Miscellaneous
Settling for PTCA Without Stent
References
16: Bifurcation Lesions
Introduction
Definition
Medina Classification
Approach to Bifurcation Intervention
Access
Guiding Catheter Selection (Table 16.1)
Optimal Angiographic Views
Coronary Wiring
Lesion Preparation
Bifurcation Algorithm (Fig. 16.2)
Provisional Stenting Approach
Two-Stent Approach
References
17: Ostial Lesion Interventions
Introduction
Ostial Lesion
Definition
Etiology
Anatomic Challenges
Equipment
Access
Fluoroscopic Views
Step-by-Step Approach
Accuracy of Stent Placement
Complications [9]
References
18: Left Main Coronary Interventions
Introduction
Left Main Stenosis
Location
Diagnosis of Left Main (LM) Disease
Supporting Evidence for Percutaneous Intervention for Left Main Stenosis
EXCEL Trial [4]
NOBLE Trial [5]
PRECOMBAT Trial [6]
Current Guidelines [Fig. 18.3]
Protected Versus Unprotected LM Intervention
Need for Hemodynamic Support
Planning for Intervention: Simple Versus Complex Lesion (DEFINITION Study)
Simple vs. Complex Lesions
Femoral Versus Radial Approach
Optimal Angiographic Views
Approach
Ostial LM
Mid-LM
Distal LM
Provisional Stenting
Two-Stent Strategy
SKS/V Stent
Mini Crush
Double Kissing CRUSH (DK-CRUSH)
Culotte Stenting
T-Stenting and Small Protrusion (TAP)
Trifurcation of Distal LM
Imaging after Stent Placement
Antiplatelet Selection
Surveillance Angiography
References
19: Chronic Total Occlusions
Introduction
CTO Principles for Best Practice
Angiogram Analysis
Good CTO PCI Clinical Practice
Crossing Strategies
CTO Procedural Components
Vascular Access
Sheath
Guides
Guidewires
CTO with Micro-Channels
CTO with Calcification
Tips and Tricks for CTO Wiring
Microcatheters
Traversing the CTO Length
Parallel Wire Technique
After Crossing
Microcatheter Not Crossing (Uncrossable Lesion)
Retrograde Approach
Selection of Collaterals
Retrograde CTO Steps
When to Stop a CTO Recanalization Attempt
References
20: Acute Coronary Syndrome: STEMI and Non-STEMI Interventions
Introduction
Acute Coronary Syndrome Basic Management
Non-STEMI [1]
Dual Antiplatelet Therapy [2]
Anticoagulation (One of the Following)
Adjunctive Medical Therapy
Drug Eluting Stent (DES)
Duration of Dual Antiplatelet Therapy Post PCI
STEMI [3]
Dual Antiplatelet Therapy
Anticoagulation
Vascular Access
Diagnostic Angiogram
Coronary Intervention [5]
Treatment of Distal Embolization/Slow Flow/No Reflow
Management of Non-culprit Lesion [5, 6]
References
21: Coronary Artery Bypass Graft Interventions
Introduction
SVG Interventions
Basics
Equipment
Access
Fluoroscopic Views
Steps by Step Approach
Complications
Arterial Graft Interventions
Basics
Equipment
Access
Fluoroscopic Views
Step-by-Step Approach
Complications
References
22: Severely Calcific Coronary Artery Lesion Interventions
Introduction
Super-High Pressure Noncompliant Balloon
Atherotomy: Cutting Balloon
FlextomeTM
WolverineTM
Technical Considerations
Atherotomy: Scoring Balloon
AngioSculptTM
Atherotomy: Constrained Semi-compliant Balloon Angioplasty
Rotational Atherectomy
Rotational Atherectomy Steps
Complications of Rotational Atherectomy
Orbital Atherectomy
Orbital Atherectomy Steps:
Rotational Atherectomy vs. Orbital Atherectomy (Table 22.1)
Excimer Laser Coronary Atherectomy
Intracoronary Lithotripsy: Shockwave C2 ™
References
23: Transradial Coronary Interventions
Introduction
Basic Catheter Techniques for Diagnostic Angiography
Left or Right Radial Artery Access
Navigation
Radial Diagnostic Catheters
Cannulation
Specialized Catheters
Transradial PCI
Guiding Catheter Selection
Other Equipment
Post-Procedure Care
Discharge Instructions
Troubleshooting
Spasm
Subclavian Loop
Radial Artery Tortuosity and Loops
Arteria Lusoria (Lusorian Artery)
Catheter Kinking
Complications [3–6]
Radial Artery Occlusion
Radial Artery Pseudoaneurysm
Brachial Artery (BA) or Subclavian Artery (SA) Dissection
Reflex Sympathetic Dystrophy
Hematoma, Perforation, and Compartment Syndrome
Hematoma Classification after Transradial or Transulnar PCI
References
24: Coronary Complications and Management of Percutaneous Coronary Interventions
Introduction
Coronary Perforation
Classification
Outcomes
Treatment
Ellis Type I Coronary Perforations
Ellis Type II/III Coronary Perforations
Abrupt Vessel Closure
General Treatment
Coronary Artery Dissection
Air Embolism
Guide Catheter Dissection
No-Reflow Phenomenon
Periprocedural Myocardial Infarction
Complication of Rotational Atherectomy: Burr Entrapment
Device Embolization
Stents Embolization
Wire Embolization
Longitudinal Stent Deformation
References
Part III: Special Procedures
25: Contrast-Induced Nephropathy Post Percutaneous Interventional Procedures
Introduction
Definition
Epidemiology
Pathophysiology
Identification of High-Risk Patients
Prevention
Post-Procedure Monitoring and Treatment
References
26: Intracoronary Stent Restenosis
Introduction
Angiographic Definition and Classification
Mechanisms
Pathological Images of ISR
Role of Intravascular Imaging
Representative OCT Images of ISR
Treatment for ISR
High-Pressure Noncompliant Balloons
Cutting and Scoring Balloons
Debulking Techniques
Repeat DES
Drug-Coated Balloon (DCB)
Intravascular Brachytherapy (IVBT)
New Classification for DES-ISR Based on Intracoronary Imaging
Algorithm for the Treatment of DES Restenosis at Mount Sinai Hospital
Conclusion
References
27: Advanced Hemodynamic Support
Introduction
Commonly Used Advanced Hemodynamic Support
Intra-Aortic Balloon Pump (IABP)
Contraindications
Complications
Balloon Size
Access
Balloon Preparation Before Insertion
Balloon Insertion
Troubleshooting
Timing Errors: Adjust the Onset of Inflation/Deflation
Gas Loss
Catheter Restriction
Impella
Contraindications
Preimplantation
Implantation
Troubleshooting
Potential Complications
Extracorporeal Membrane Oxygenation (ECMO)
Indications
Contraindications
Complications
Cannula Size and Access Site Considerations
Steps of Implantation
RV Impella
Contraindications
Steps of Implantation
Complications
TandemHeart
Contraindications
Steps of Implantation
Complications
Protek Duo
Contraindications
Complications
References
28: Aortic Valve Interventions: Balloon Aortic Valvuloplasty and Transcatheter Aortic Valve Replacement
Introduction
Balloon Aortic Valvuloplasty (BAV)
Indications
Contraindications
Equipment
Vascular Access
Crossing of the Aortic Valve
Balloon Management
Temporary Pacemaker Use
Balloon Inflation
Balloon Deflation
Post-procedure Assessment
Complications
Sheath Removal
Post-procedure Management and Monitoring
Transcatheter Aortic Valve Replacement (TAVR)
Balloon Expandable Valve: SAPIEN Family of Valves
Sizes Available
Table Setup
Sheath Introducer Set Preparation
Balloon Catheter Preparation
Delivery System Preparation
Access Preparation for Transfemoral Approach
Implantation Angle
Crossing the Valve and Wire Positioning
Advancement of the Delivery System
Align the Valve
Crossing the Aortic Valve with Edwards SAPIEN Delivery System
Edwards SAPIEN Delivery System
TAVR in Low Risk Patients
Cerebral Embolic Protection Device (EPD)
Self-Expanding Valve: Evolut PRO PLUS CoreValve
Sizes Available
Loading the Valve
Loading Steps: Configure Loading Tray
Rinse the Valve
Flush Capsule
Misloads
Procedural Steps
Deployment Steps
Final Release
Removal of the Delivery System
Troubleshooting Techniques
References
29: Guide Catheter Selection in Patients with Transcatheter Aortic Valve Replacement
Introduction
Coronary Artery Disease and TAVR
Challenges in Accessing Coronaries After TAVR
Practical Considerations
Geometric Interaction Between Self-Expanding and Balloon-Expandable Valves and Coronary Ostia
Self-Expandable Valve
Balloon-Expandable Valve
Systematic Approach to Selecting a Diagnostic Coronary Catheter in Patients with a TAVR
Systematic Approach to Selecting a Guiding Catheter for PCI in Patients with a TAVR
References
30: Percutaneous Transvenous Mitral Commissurotomy
Introduction
Percutaneous Transvenous Mitral Commissurotomy (PTMC)
Indications
Contraindications to Percutaneous Transvenous Mitral Commissurotomy (PTMC)
Preparation
Equipment
Vascular Access for Definite BMV
Vascular Access for Possible BMV
Procedural Steps
Transseptal Puncture Using Fluoroscopy
Transseptal Puncture Using TEE
Balloon Preparation
Balloon Insertion and Crossing the Mitral Valve
Complications and Their Management
Post-Procedure Care and Follow-Up
References
31: Transcatheter Edge to Edge Mitral Valve Repair
Introduction
MitraClip
Indications
TEE Views for MitraClip
Step-by-Step MitraClip
Septal Puncture
Insertion of Steerable Guide Catheter
Insertion and Steering of CDS
Optimize Clip Orientation
Ready to Enter into LV
Grasping Leaflets in LV
Assessment of Clip After Grasping
Clip Deployment
Assessment After First Clip
Annexure: MitraClip TTE/TEE Information Sheet
References
32: Alcohol Septal Ablation
Introduction
Alcohol Septal Ablation
Criteria
Access
Equipment
Hemodynamic Assessment
Technique
Post-Procedure
Complications
Post-Procedure
References
33: Pericardiocentesis and Balloon Pericardiotomy
Introduction
Pericardiocentesis
Indications
Contraindications
Etiologies
Equipment
Step-By-Step Approach
Post-Procedure Management
Complications
Percutaneous Balloon Pericardiotomy
Indications
Contraindications
Equipment
Procedure
Post-Procedure
Pericardial Window
References
Index