Coronary angiography and PCI

Transcription

1 Coronary arteries Coronary angiography and PCI Samo Granda, Franjo Naji Department of Cardiology Clinical department of internal medicine University clinical centre Maribor Coronary arteries Atherosclerosis Myocardial infarction Coronary angiography (CA) invasive diagnostic method for visualization of coronary arteries Percutaneous coronary intervention (PCI) any therapeutic coronary procedure usually following CA PTCA (percutaneous transluminal coronary <baloon> angioplasty), stent implantation, thrombus aspiration... 1

2 Indications for CA: suspected coronary disease (angina pectoris) acute coronary syndrome (STEMI, NSTEMI, UA) cardiomyopathies (exclusion of ischaemic etiology) sudden cardiac death (VF...) before planned surgical procedure (heart valves...) before heart transplantation Coronary catheterisation laboratory: flouroscopic imaging system (C-arm, x-ray tube, flouroscopic monitors, physiologic monitors, contrast injector...) patient table radiation free monitoring location radiation safety (glasses, thyroid shield, lead coat) rescuscitation equipment, drugs... Femoral or radial access site patient conscious but slightly sedated patient in supine position on the table sterile preparation (vascular site, equipment, operators...) 2

3 Femoral artery approach 3

4 J tipped Guidewire the 0,035'' guidewire with J tip in introduced through the vascular sheath the wire is pushed forward under flouroscopic guidance to the ascending aorta a diagnostic left coronary catheter is inserted over the wire the catheter is pushed to the ascending aorta the wire is removed the catheter is connected to the hemodynamic monitoring and contrast delivery device Diagnostic coronary catheters a diagnostic coronary catheter is rotated and manipulated to engage the coronary ostium the contrast is delivered to ensure the right placement of the catheter x-ray C-arm is rotated to the standard projections (views) a small amount of contrast is delivered in every projection a cine loop is recorded in every projection 4

5 Coronary x-ray projections (views) Coronary x-ray projections (views) Left coronary artery LAO45/CR20 Left coronary artery LAO45/CA20 Left coronary artery RAO10/CA20 Left coronary artery RAO10/CR30 5

6 a diagnostic left coronary catheter is removed from the coronary ostium a guidewire is introduced and catheter removed a diagnostic right coronary catheter is guided to the ascending aorta a guidewire is removed a diagnostic right coronary catheter is rotated and manipulated to engage the right coronary ostium the contrast is delivered to ensure the right placement of the catheter cine loops are recorded in standard views Right coronary artery LAO40 Right coronary artery RAO40 A real case: a diagnostic right coronary catheter is removed from the coronary ostium a guidewire is introduced and catheter removed 6

7 A real case: A real case: after the coronary stenosis is located a guiding catheter is introduced over the wire and inserted into coronary ostium the coronary wire 0,018'' is guided through the catheter once in the coronary artery, the wire is gently pushed, rotated and manipulated to guide it through the area of stenosis Coronary wires Coronary wires Coronary wire accross the stenosis 7

8 Coronary wire accross the stenosis the baloon catheter is inserted over the coronary wire and pushed to the place of the stenosis once the baloon catheter is in the right place it is inflated for about 10 seconds and then deflated - PTCA baloon catheter is removed into the guiding catheter and the angiographic result is recorded Baloon catheters PTCA PTCA PTCA 8

9 PTCA PTCA the baloon catheter is removed the coronary stent is inserted over the coronary wire and pushed to the place of the stenosis once the stent is in the right place it's baloon is inflated for about seconds and then deflated the stent catheter is removed into the guiding catheter and the angiographic result is recorded Coronary stenting Coronary stenting Coronary stenting 9

10 Coronary stenting final result Coronary stenting final result Other coronary procedures: Bifurcation treatment complex stenting of multivessel disease bifurcation lesions stenting of left main artery PCI of chronic total occlusions thrombus aspiration covered stent implantation rotablation (rotational atherectomy) IVUS, OCT, FFR OCT and IVUS Complications of PCI: unsuccessful / incomplete revascularization coronary dissection coronary rupture stent thrombosis distal coronary embolization 10

11 Removal of femoral arterial sheath haematoma A-V fistula pseudoaneurysm patient must remain in supine position for 5-6 hours very uncomfortable Removal of radial arterial sheath fewer complications patient can walk after the procedure Thank you! 11