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preferred cardiac contrast in catheterization

Peter Paik, Sanjay K Arukala, Anupam A Sule
Central venous catheters are placed in approximately five million patients annually in the US. The preferred site of insertion is one with fewer risks and easier access. Although the right internal jugular vein is preferred, on occasion, the left internal jugular may have to be accessed. A patient was admitted for septic shock, cerebrovascular accident, and non-ST-segment elevation myocardial infarction. A central venous line was needed for antibiotic and vasopressor administration. Due to trauma from a fall to the right side and previously failed catheterization attempts at the left subclavian and femoral veins, the left internal jugular vein was accessed...
January 9, 2018: Curēus
Jimmy Yee, Vishesh Kumar, Shenjing Li, Terezia Petraskova, Alex Pham, Julia Stys, Paul A Thompson, Marian Petrasko, Adam Stys, Tomasz Stys
OBJECTIVES: To analyze clinical factors associated with operator's preference in selection of femoral versus radial access for angiography and percutaneous intervention (PCI) procedures. BACKGROUND: There has been an increase in radial access in cardiac catheterization and PCI in the last few decades. METHODS: Data from 11 226 consecutive cardiac catheterization procedures were collected from Sanford University Medical Center (University of South Dakota, Sanford School of Medicine) from 2011 to 2015...
December 25, 2017: Journal of Interventional Cardiology
Thorsten Feldkamp, Maya Luedemann, Martina E Spehlmann, Sandra Freitag-Wolf, Julia Gaensbacher, Kevin Schulte, Amer Bajrovic, Dieter Hinzmann, Hans-Joerg Hippe, Ulrich Kunzendorf, Norbert Frey, Mark Luedde
OBJECTIVES: To assess, whether cardiac catheterization via radial access prevents contrast-induced nephropathy. BACKGROUND: Contrast-induced nephropathy (CIN) is a major clinical problem which accounts for more than 10% of acute kidney injury cases in hospitalized patients. Protective measures such as the infusion of isotonic saline solution or acetylcysteine have not consistently been proven to prevent acute kidney injury (AKI). However, there is growing evidence that radial access for coronary angiography and coronary intervention is associated with a lower incidence of AKI compared to femoral access...
February 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Francesca Del Furia, Gennaro Giustino, Alaide Chieffo
INTRODUCTION: Transradial access (TRA) emerged in the last two decades as a valid alternative to the standard transfemoral access (TFA) for cardiac catheterization and percutaneous coronary intervention (PCI). Due to contrasting results, the penetration and uptake of TRA in real-world clinical practice has been slow and still limited to high experienced center. EVIDENCE ACQUISITION: We performed an updated systematic review and study-level meta-analysis of randomized controlled trials (RCTs) that investigated the efficacy and safety of TRA versus TFA for PCI in patients with ACS...
December 2016: Panminerva Medica
Alberto Polimeni, Francesco Passafaro, Salvatore De Rosa, Sabato Sorrentino, Daniele Torella, Carmen Spaccarotella, Annalisa Mongiardo, Ciro Indolfi
The radial artery has been increasingly used for its favorable safety profile. However, no conclusive data are available on the optimal sheath size. In particular, it is seemingly difficult to weight both advantages and disadvantages of narrower versus larger sheaths size. Despite several studies were performed to compare the use of 6-Fr to the smaller 5-Fr sheaths, these were mostly small, single center-studies, yielding various results.We performed a comprehensive meta-analysis of all available studies comparing the use of 5-Fr versus 6-Fr sheaths in coronary procedures through the TRA...
December 2015: Medicine (Baltimore)
B Kelly Han, Marko Vezmar, John R Lesser, Gregory Michalak, Katharine Grant, David Dassenko, Jill Maresh, David M Overman
OBJECTIVES: To assess the accuracy and risk of substituting cardiac computed tomography for cardiac catheterization in select patients for evaluation of anatomy before second-stage single ventricle palliation. METHODS: This is a retrospective review of consecutive diagnostic cardiac catheterization (n=16) and computed tomography studies (n=16) performed before second-stage single ventricle palliation from March 2010 to July 2012 at a single institution. Risk (anesthesia, vascular access, contrast, and radiation exposure), accuracy, and postoperative course were compared...
October 2014: Journal of Thoracic and Cardiovascular Surgery
William Wilson, James C Spratt
There have been many technological advances in antegrade CTO PCI, but perhaps most importantly has been the evolution of the "hybrid' approach where ideally there exists a seamless interplay of antegrade wiring, antegrade dissection re-entry and retrograde approaches as dictated by procedural factors. Antegrade wire escalation with intimal tracking remains the preferred initial strategy in short CTOs without proximal cap ambiguity. More complex CTOs, however, usually require either a retrograde or an antegrade dissection re-entry approach, or both...
May 2014: Current Cardiology Reviews
Fabian Rengier, Philipp Geisbüsch, Paul Schoenhagen, Matthias Müller-Eschner, Rolf Vosshenrich, Christof Karmonik, Hendrik von Tengg-Kobligk, Sasan Partovi
Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair...
January 2014: VASA. Zeitschrift Für Gefässkrankheiten
Robert Applegate, Matthew Sacrinty, Pascha Schafer, Justin Smith, Sanjay Gandhi, Michael Kutcher, Renato Santos, Adam Cecile, William Little
OBJECTIVES: To evaluate the cost effectiveness of diagnostic cardiac catheterizations (CATH) and coronary interventions (PCI) performed using radial artery (RA) access compared to femoral artery (FA) access. BACKGROUND: CATH and PCI performed from the RA reduce access site complications compared to FA, but can increase procedure duration, and equipment and contrast use. Whether resulting increases in utilization costs are offset by reduced costs of complications is uncertain...
October 1, 2013: Catheterization and Cardiovascular Interventions
Victar Hsieh, Shamir R Mehta
Primary angioplasty of the culprit coronary artery lesion is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) when timely access to a catheterization laboratory is available. The presence of multi-vessel disease (MVD) in patients undergoing primary PCI is common, occurring in about 40 %-50 % of patients. The presence of MVD in patients who have undergone successful primary PCI substantially increases the risks of mortality and major adverse cardiac events, such as reinfarction or need for urgent revascularization...
February 2013: Current Treatment Options in Cardiovascular Medicine
Johannes Rixe, Annika Schuhbaeck, Christoph Liebetrau, Helge Moellmann, Holger M Nef, Sebastian Szardien, Roland Brandt, Joern Schmitt, Thomas Neumann, Christian Schneider, Gabriele Krombach, Christian W Hamm, Stephan Achenbach, Andreas Rolf
OBJECTIVES: In transcatheter aortic valve implantation (TAVI), assessment of the aortic annulus is mandatory. We sought to investigate the correlation between trans-oesophageal echocardiography (TEE) and multi-detector computed tomography (MDCT) for annulus diameter assessment before TAVI. METHODS: A total of 122 patients (67 male, mean age 84 ± 6 years) underwent MDCT and TEE for TAVI planning. In TEE annulus diameters were obtained in a long-axis view at diastole...
December 2012: European Radiology
Petr Kala, Jan Kanovsky, Richard Rokyta, Michal Smid, Jan Pospisil, Jiri Knot, Filip Rohac, Martin Poloczek, Tomas Ondrus, Maria Holicka, Jindrich Spinar, Jiri Jarkovsky, Ladislav Dusek
BACKGROUND: Older age, as a factor we cannot affect, is consistently one of the main negative prognostic values in patients with acute myocardial infarction. One of the most powerful factors that improves outcomes in patients with acute coronary syndromes is the revascularization preferably performed by percutaneous coronary intervention. No data is currently available for the role of age in large groups of consecutive patients with PCI as the nearly sole method of revascularization in AMI patients...
2012: BMC Cardiovascular Disorders
Rolf Dörr, Reinhardt Sternitzky
In Germany, every second left heart catheterization has no immediate interventional or surgical consequence. One main reason for this limited quality of indication of many left heart catheterizations is presumably the inaccuracy of preinvasive testing that is mainly based on clinical evaluation and exercise ECG in Germany. However, exercise electrocardiography has several limitations. The central issues are the inability to exercise in many, especially elderly patients, and the missing interpretability of the stress ECG in cases with already pathological rest ECG...
May 2011: Clinical Research in Cardiology Supplements
Abdul Basit, Raja Nazir, Harvey Hahn
A 69-year-old male presented with inferior wall ischemia. Transradial coronary angiogram with an Optitorque Jacky shape catheter showed unobstructed coronary arteries (Terumo Medical Corporation). Left ventriculography was complicated with myocardial and pericardial contrast staining. The catheter was pulled back. The patient experienced sharp chest pain that resolved in 20 minutes. Stat transthoracic echocardiogram was unremarkable. The patient remained hemodynamically stable. Transthoracic echocardiogram the next morning revealed trivial pericardial effusion...
March 2012: Journal of Invasive Cardiology
Samuel Turner, Matthew Sacrinty, Michael Manogue, William Little, Sanjay Gandhi, Michael Kutcher, Renato Santos, Robert Applegate
OBJECTIVES: To evaluate procedural and safety metrics of transradial (TR) versus transfemoral (TF) cardiac catheterization (CATH) and percutaneous coronary interventions (PCI) during a complete institutional transition from TF to TR as the preferred access. BACKGROUND: The TR approach has been shown to reduce complications compared to TF for CATH and PCI, but concerns of longer procedure times have limited utilization in the United States. METHODS: 4,172 consecutive CATH and PCI procedures were performed (2,665 TF; 1,507 TR) at Wake Forest Baptist Medical Center from January 2009 to November 2010...
August 1, 2012: Catheterization and Cardiovascular Interventions
Marc Dewey, Elke Zimmermann, Florian Deissenrieder, Michael Laule, Hans-Peter Dübel, Peter Schlattmann, Fabian Knebel, Wolfgang Rutsch, Bernd Hamm
BACKGROUND: Noninvasive coronary angiography with the use of multislice computed tomography (CT) scanners is feasible with high sensitivity and negative predictive value; however, the radiation exposure associated with this technique is rather high. We evaluated coronary angiography using whole-heart 320-row CT, which avoids exposure-intensive overscanning and overranging. METHODS AND RESULTS: A total of 30 consecutive patients with suspected coronary artery disease referred for clinically indicated conventional coronary angiography (CCA) were included in this prospective intention-to-diagnose study...
September 8, 2009: Circulation
Hwa Yeon Lee, Seung Min Yoo, Charles S White
Immediate coronary catheterization is mandatory for high risk patients with typical chest pain in the emergency department (ED). In contrast, in ED patients with acute chest pain but low to intermediate risk, traditional management protocol includes serial ECG, cardiac troponins and radionuclide perfusion imaging. However, this protocol is time-consuming and expensive, and definite treatment of unstable angina is often delayed. Due to advances of multi-detector CT (MDCT) technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary syndrome in ED patients with acute chest pain...
March 2009: International Journal of Cardiovascular Imaging
Marc Dewey, Florian Teige, Dirk Schnapauff, Michael Laule, Adrian C Borges, Klaus-Dieter Wernecke, Tania Schink, Gert Baumann, Wolfgang Rutsch, Patrik Rogalla, Matthias Taupitz, Bernd Hamm
BACKGROUND: Multislice computed tomography (CT) and magnetic resonance imaging (MRI) are the main candidates for noninvasive coronary angiography; however, multislice CT, unlike MRI, exposes patients to radiation and an iodinated intravenous contrast agent. OBJECTIVE: To compare the diagnostic accuracy of multislice CT and MRI for noninvasive detection of clinically significant coronary stenoses (> or =50%). DESIGN: Prospective intention-to-diagnose study...
September 19, 2006: Annals of Internal Medicine
Kunadian Vijayalakshmi, David Williams, Robert A Wright, James A Hall, Alun A Harcombe, Nicholas J Linker, Michael J Stewart, Adrian Davies, Mark A de Belder
BACKGROUND: Intravascular contrast agents presently used in modern digital catheter laboratories during cardiac catheterization are superior to older agents as regards patient tolerance. There are, however, significant differences between these agents. PURPOSE: The aim of this study was to determine the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 2 contrast agents currently used during cardiac catheterization: iopamidol 340 (Niopam) and iobitridol 350 (Xenetix)...
December 2004: Journal of Invasive Cardiology
Joachim Hebe
The role of surgery and radiofrequency current ablation for the treatment of tachycardias in patients with congenital heart disease The use of radiofrequency current application as a treatment strategy has stimulated a revolution in our understanding of tachycardia mechanisms. The extension of its use to patients with congenital heart defects and tachyarrhythmias has opened the door to new treatments with known success rates and known risks for mortality and morbidity. Antiarrhythmic surgery aims to dissect or excavate a responsible substrate and is especially worth considering if cardiac surgery is being undertaken for other reasons...
August 2002: Cardiology Clinics
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