Manual of Percutaneous Coronary Interventions

Stenting

Goal : To deliver and adequately expand a stent, completely covering the target lesion. 10.1 You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in…

Lesion preparation

9.1 Goal To adequately prepare the target lesion to facilitate stent delivery and expansion. 9.2 When is lesion preparation needed? ( Fig. 9.1 ) Lesion preparation (in most cases with balloon angioplasty) should be performed in nearly all lesions because…

Wiring

Goal : To advance a guidewire through and distal to the target coronary lesion in the most efficient way and without causing a complication and to provide an adequate platform to support balloon, stent and other equipment delivery. Similar to…

Selecting target lesion(s)

The following decisions need to be made after coronary angiography is performed. 1. Is coronary revascularization needed? Like every other procedure, coronary revascularization should be done when the anticipated benefits exceed the potential risks. Potential benefits are improving symptoms and…

Coronary angiography

Although adjunctive modalities (stress testing, noninvasive imaging including coronary computed angiography, coronary physiology, and intracoronary imaging) can help evaluate coronary anatomy, coronary angiography remains the most commonly used technique for assessing the presence and severity of coronary artery stenoses and…

Coronary and graft engagement

In Chapter 4 , Access, we discussed about how to obtain arterial access. In this chapter we describe the steps involved in advancing a catheter over a guidewire from the access site to the coronary ostia and engaging the coronary…

Access

4.1 Choosing access site Obtaining arterial access is required for performing diagnostic coronary angiography and percutaneous coronary intervention (PCI). There is continued controversy about optimal access site selection. Radial (proximal or distal) or ulnar access is associated with significantly fewer…

Medications

In this chapter we discuss the following classes of medications that are commonly used in the cardiac catheterization laboratory: 1. Sedatives and analgesics 2. Vasodilators 3. Contrast media 4. Anticoagulants 5. Antiplatelet agents 6. Vasopressors and inotropes 7. Antiarrhythmics 3.1…

Monitoring

Monitoring the patient should be continually performed from the beginning to the end of the case, so that potential complications are promptly identified and corrected. The following parameters are assessed ( Fig. 2.1 ). Open full size image Figure 2.1…

Planning

If you fail to plan you are planning to fail. Benjamin Franklin. Planning is essential for every procedure, including percutaneous coronary intervention (PCI). Thoughtful planning and appropriate preparation before performing PCI improves the safety, efficiency, outcome, and cost of the…