Essential Angioplasty (eBook)

E. von Schmilowski, R. H. Swanton (Autoren)

eBook Download: EPUB

2011
John Wiley & Sons (Verlag)
978-1-119-95052-3 (ISBN)

Infos

A vast choice of techniques and technology confronts today's interventional cardiologists, and those who are new to angioplasty need clear and practical guidance in order to develop good habits, avoid common pitfalls and complications, and become efficient and confident practitioners. This new book supplies a solid grounding in the basics of percutaneous techniques by providing selective, practical knowledge and a full range of useful tools and tips. Throughout, the authors follow the motto 'keep it simple' and focus only on the information that will help the reader learn and master the relevant technique. The book is designed for ease of use in the cath lab or other situations where the reader needs to access information quickly.

E. von Schmilowski, MD, PhD, Specialist Registrar Cardiologist, The Heart Hospital, London, UK

R. H. Swanton, MD, Consultant Cardiologist, The Heart Hospital, London, UK

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A vast choice of techniques and technology confronts today s interventional cardiologists, and those who are new to angioplasty need clear and practical guidance in order to develop good habits, avoid common pitfalls and become efficient and confident practitioners. Written to provide readers with a solid grounding in the basics of percutaneous techniques by providing selective, practical knowledge and a full range of useful tools and tips, Essential Angioplasty is: Ideal for those seeking a solid foundation in percutaneous interventions Designed for ease of use and retention of information; copiously illustrated with clear "e;take home messages"e; concluding each chapter Packed with over 300 tips and tricks which readers can apply in their training and practice Based on the authors' hands-on experience in the world's leading interventional cardiology training centers and years of proven teaching experience Throughout, the authors follow the motto "e;keep it simple"e; and focus only on the information that will help the reader learn and master the relevant technique. This makes Essential Angioplasty the perfect companion for trainees and others seeking a reliable guide to achieving success in the cardiac catheterization laboratory.

Inhalt

Foreword, vii

Preface, viii

Acknowledgments, x

List of Abbreviations, xi

Chapter 1 Fundamentals, 1

Standards of Excellence in Interventional Cardiology, 1

Introduction to Interventional Procedures, 4

Vascular Access, 8

Coronary Anatomy and Projections, 25

Anomalies, 41

Left Ventriculography and Aortography, 51

Radiation Safety, 58

Chapter 2 Devices in Practice, 66

Guiding Catheters, 66

Guide Wires, 92

Balloons, 99

Stents, 110

Closure Devices, 122

Chapter 3 The Interventional Patient, 129

Elective PCI for Stable Coronary Artery Disease, 129

PCI in Acute Coronary Syndromes, 133

The Diabetic Patient, 162

Chapter 4 Interventional Pharmacotherapy, 167

Antiplatelet Agents in PCI, 167

Antithrombotic Agents in PCI, 182

Chapter 5 Techniques in Specifi c Lesions, 189

Left Main Coronary Artery, 189

Bifurcation Lesions, 203

Ostial Lesions, 238

Chronic Total Occlusion, 252

Grafts and Conduits, 273

Chapter 6 Complications, 288

Contrast Reactions, 288

Femoral Access Site Problems, 289

Radial Access Site Problems, 293

Air Injection, 294

No-Refl ow/Slow-Refl ow Phenomenon, 294

Coronary Spasm, 296

Pseudostenoses, 296

Coronary Perforation, 296

Coronary Dissection, 299

Stent Thrombosis, 303

Restenosis, 307

Stent Loss, 310

Hypotension, 311

Hypoglycemia, 312

Contrast-Induced Nephropathy, 312

New ST Elevation or Marked ST Depression, 317

Cardiac Arrest, 317

Emergency CABG, 319

Death, 319

Chapter 7 Intracoronary Imaging, 320

Intravascular Ultrasonography, 320

Virtual Histology, 335

Fractional Flow Reserve (FFR), 336

Optical Coherence Tomography, 339

List of Trials and Studies, 345

References, 348

Trials, 348

Guidelines, 357

Other Resources, 357

Index, 359

Rezensionen

"This is a concise, well-written handbook that will serve
as an easy quick reference guide to cardiac angiography and
intervention." (Doody's, 17 August
2012)

Textauszug

CHAPTER 1

Fundamentals

Standards of Excellence in Interventional Cardiology

Introduction to Interventional Procedures

Vascular Access

Coronary Anatomy and Projections

Anomalies

Left Ventriculography and Aortography

Radiation Safety

Standards of Excellence in Interventional Cardiology

As you are reading this, interventional cardiology has become an important part of your life. After a demanding training and long hours in hospital cardiology practice you have become a member of the interventional community. You undoubtedly have great potential, strong motivation, and a determination to learn and master your profession.

Interventional cardiology is not only about how educated, intelligent, or skilled you are. Good qualifications are indeed important, but being an excellent operator does not necessarily make you an excellent interventional cardiologist. There is much more to it than educational achievements and manual skills.

A skilled angioplasty operator should select patients appropriately and use the best and most up-to-date techniques, equipment, and pharmacotherapy. An interventional cardiologist, on the other hand, should in addition to these skills have a wide knowledge base, common sense, and the ability to cooperate and communicate effectively with both colleagues and patients.

Much of what follows is about being a first-class doctor rather than being a skilled technician. It may be taken for granted by the patient and medical colleagues that the conduct described below is to be expected as part of a first-class service. However, we have all seen how pressure of time and work and the stress of a difficult procedure can erode these standards. It is important that good standards of practice should develop from the very beginning of training. You will make a positive impact on both patients and the people you work with, and in a few years time your younger colleagues will learn from you.

We hope these few practical thoughts will help you see interventional cardiology from a more human perspective and will make your profession more worthwhile, rewarding, and enjoyable.

Take Care of the Patient

• You are a physician and cardiologist, not just an interventionist. Treat the whole patient, not just the lesion in the coronary artery. Try to imagine what it must be like facing up to a coronary angioplasty.
• Meet the patient and the patient’s family before and after the procedure. Explain what will be done and what has been done.
• Be available, kind, and keen to talk. Be honest, quietly confident, and do not hide anything. In getting consent, be realistic about the risks involved. These should be the risks in your hands in your hospital, not national risks.
• During the procedure, mind your language and be careful with comments you make. Don’t forget that most patients are awake during a percutaneous coronary intervention (PCI), and sedation does not necessarily stop them hearing or remembering remarks.

Treat the patient, not the lesion.

Quality and Respect Are Essential

• Be humble and respect the people you work with. You are not the master of the universe. Don’t act in a superior way.
• Be professional. Build your reputation as a professional physician and a decent human being, not a pop star.
• Dress properly. Have clean hands and fingernails.
• Be available and well organized. Keep your desk clean, keep your files in order, manage your time effectively by planning ahead.
• Be reliable, honest, and truthful. We all want to work with people whom we can trust and rely on.
• Be effective, but not arrogant.
• Be decisive. Don’t dwell on problems, solve them. A good decision made quickly is ideal, but when you are stuck, any decision is better than no decision.
• Be strong and determined. Do not give up because things are getting difficult.
• Be adaptable as well as decisive. Be prepared to change strategy if your initial plan is not working out.
• Be a good speaker. Express your opinions in sentences rather than in paragraphs.
• Don’t argue with anyone. Accept constructive criticism.
• Be calm and peaceful. Control your emotions when things go wrong. Do not raise your voice.
• Be well balanced. Keep your mind and body in healthy shape. Your mind is like a parachute. It only works when open.

Any decision is better than no decision.

Communicate Effectively

• Cooperate with your medical colleagues and catheter lab staff.
• Present results of the procedure to your referring doctor.
• Be careful when you present your opinions about PCI performed by others and avoid disparaging or disdainful remarks.
• Consider and respect others’ views. If you disagree, disagree gracefully.
• A healthy and friendly atmosphere in the catheter lab is very important.
• Maintain a good relationship with catheter lab staff. Help them and teach them, but do not patronize them. Many of them will be highly experienced. Discuss cases with them, particularly when things go wrong.
• Remember each nurse and technician by name and thank them at the end of the procedure.
• Do not make people feel intimidated by your knowledge, experience, skills, achievements, etc. The greatest people will never make you feel intimidated.

Build bridges, not walls.

Don’t Overestimate Your Skills

• Courage is important. However, there is a thin line between courage and stupidity. The only hero in a heroic procedure is the patient. Be very cautious, particularly in the first few months of your training.
• If in doubt, ask your more experienced colleagues for their opinion. Discuss the problem with others.
• In complex cases, ask one of your colleagues to scrub in with you, even if you think you don’t need help.
• There is no failure. Only feedback. When complications occur, stay calm, manage the patient appropriately, and do not leave the bedside until the situation is under control. Once the patient is stable, immediately contact your more experienced colleague to explain the case and review the patient in detail. Always tell the truth.
• Being told you are competitive may be a compliment or an insult. PCI is not a rugby game and it is not about winning, beating others, or proving you are the best.
• Avoid “Let me show you…” situations. Compete when it is yourself you are competing against.

Skill is successfully walking a tightrope over Niagara Falls. Intelligence is not trying.

Learn, Learn, Learn

• Learn every day. Enjoy it and share your knowledge. Learn before you start practicing. Manual skills are extremely important, but without a solid theoretical background you can only be good, never great.
• Attend and participate in interventional meetings at least once a year. Euro PCR in Europe, ACI in the UK, and TCT in the USA are invaluable meetings and will broaden your horizons and inspire you. You will learn from the greatest and most experienced interventionists in the world.
• Keep up to date with interventional technology, new equipment, and new trials.

Good judgment comes from experience and experience comes from bad judgment.

Above all keep it simple. Simplicity is the ultimate sophistication.

Introduction to Interventional Procedures

• Coronary Angioplasty
• Coronary Angiography

Coronary Angioplasty

When Andreas Grüntzig introduced coronary angioplasty in man in 1977, he introduced a technique which proved to be one of the great advances in modern medicine. Major advances in technology coupled with great improvements in both X-ray and intracoronary imaging have enabled cardiologists to tackle more and more complex coronary lesions. This has saved hundreds of thousands of patients a year worldwide from the need for coronary artery bypass surgery (CABG). Coronary angioplasty has been of value in the management of patients who develop angina years after CABG and has extended treatment options in elderly or frail patients who are considered unsuitable for coronary surgery.

Coronary angioplasty has revolutionized the treatment of acute myocardial infarction (MI), replacing thrombolysis in many areas reducing hospital mortality and mortality in cardiogenic shock. It has proved its superiority over thrombolysis in acute MI, preventing postinfarct angina and recurrent infarction.

With these extraordinary advances has come an understanding of the indications for PCI. It is primarily a technique for the relief of anginal symptoms which have not responded to medical treatment. Not all patients with refractory angina should be advised to have a PCI as CABG may still be an alternative treatment option in certain groups of patients: particularly those with complex, diffuse three-vessel disease and diabetes. PCI can be of value as part of a hybrid procedure: e.g., stenting of a coronary lesion before a transcatheter aortic valve implantation (TAVI). The points below indicate some common clinical situations where PCI should be considered:

• Stable angina resistant to medical treatment
• Symptomatic one-, two-, or three-vessel disease (based on the result of the stress test and suitable coronary anatomy)
• Angina with a poor exercise test result: e.g., ST depression at low workload with symptoms, or inadequate BP response
• ST elevation MI (STEMI)
• Unstable angina /...

Produkt-Details

• Erscheint lt. Verlag: 19.12.2011
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizinische Fachgebiete ► Chirurgie ► Herz- / Thorax- / Gefäßchirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Schlagworte: Basics • Cardiologists • Cardiovascular Disease • Choice • clear • Common • confronts • ease • full • Good • Habits • Interventional • Kardiovaskuläre Erkrankung • Kardiovaskuläre Erkrankungen • Kardiovaskuläre Erkrankung • Kardiovaskuläre Erkrankungen • Medical Science • Medizin • New • Order • Percutaneous • Practical • provide readers • Range • selective • solid • techniques • Technology • todays • Tools • useful • vast
• ISBN-10: 1-119-95052-X / 111995052X
• ISBN-13: 978-1-119-95052-3 / 9781119950523