Transcript Coronary Angiography and Anatomy Cardiovascular Fellows

Northwestern Memorial Hospital
Healthy Transitions Fall Program
October 7, 2013
Coronary Artery Disease:
Diagnosis and Treatment
Mark J. Ricciardi, MD
Director, Interventional Cardiology and Cardiac Catheterization
Northwestern Bluhm Cardiovascular Institute
Outline
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Coronary artery disease (CAD) basics
Diagnosis of CAD
– Cardiac Catheterization / Coronary Angiography
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Treatment of CAD
– Coronary Angioplasty / Stent
– Past, present, future
Coronary Disease
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Atherosclerosis
– ‘Arteriosclerosis’
– Fatty buildup in lining of artery wall
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Plaque
– Impinges on flow
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Reduces amount of blood and oxygen
delivered to the heart muscle
Cholesterol deposition
Early CAD
Vulnerable Plaque
Plaque Rupture
Coronary Thrombosis
“Heart Attack”
CAD
the goal…
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is prevention
– Primary prevention
Prevent early / sub-clinical stages
 Heart healthy lifestyle
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– Starting in childhood
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Medications
– Targeted at high risk groups
Diagnosis of CAD
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History
– Symptoms
– Angina
Diagnosis of CAD
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History
– Symptoms
– Angina
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Non-invasive imaging
– Stress testing
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provocation
– CT angiogram
 good, not great
Diagnosis of CAD
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History
– Symptoms
– Angina
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Non-invasive imaging
– Stress testing
– CT angiogram
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Invasive imaging
– Left heart catheterization / coronary
angiography … the gold standard for Dx
Coronary Angiography
Purposes
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Define coronary anatomy, and presence,
absence, degree obstruction
Most commonly used to:
– determine extent of CAD
– assess feasibility and appropriateness of
mechanical revascularization
Catheterization
Catheterization
Coronary Angiography
Coronary Angiography
Arterial access
Femoral artery

Most common access site
– since 1980s
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Easy and reliable
Often requires 20-30 minutes
of pressure to prevent bleeding
- followed by bed-rest
1% risk significant bleeding
There are new strategies that
hasten recovery time
– Bleeding still an issue
Arterial access
Radial artery
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Lower risk of significant
bleeding
No bed rest required
Arterial access
Radial artery
Arterial access
Radial artery
“Down side”
-the learning curve
CAD Treatment
CAD Treatment
The past…
CAD Treatment
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Secondary prevention
– Lifestyle modification
Diet, exercise, tobacco cessation
 Rx underlying risk factors
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– Aspirin and ‘statin’ medications
– Anti-anginal medications
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Beta blockers
Coronary Bypass
Coronary Angioplasty
Coronary Angioplasty
Coronary Stenting
Coronary Stenting
Drug Stents
Northwestern Memorial Hospital
Cardiac Catheterization Center
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Chicagoland’s First:
– Coronary Stent (1990s)
– Drug eluting stent (early 2000s)
Northwestern Memorial Hospital
Cardiac Catheterization Center
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Chicagoland’s First:
– Coronary Stent (1990s)
– Drug eluting stent (early 2000s)
– Bio-absorbable stent (2013)
Next Generation Stents
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Bioabsorbable /
dissolving stents
In clinical trials at
Northwestern
Conclusions
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CAD
– Sub-clinical plaque formation
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Symptomatic CAD
– Angina, heart attack
– Non-invasive and invasive testing
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CAD Treatment
– Behavioral, pharmacologic, mechanical
– NW big part of the past, present and future of
CAD Rx
Questions?
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http://watchlearnlive.heart.org/CVML_Player.php?m
oduleSelect=angiog
http://www.scai.org/PatientEducation/default.aspx
Judkins Technique
JL and JR catheters
Melvin Judkins
Cineangiography
Angiographic views
Femoral Artery Hemostasis
Perclose Suture-Mediated Closure System (Abbott
Vascular)
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Non-braided polyester
suture
Automated knot tying
Closure of 5-8Fr. access
sites
‘pre-closure’
Transradial Angiography / Intervention
Anatomy
No associated major nerve
Median N in carpal tunnel
Ulnar N runs with UA
Dual arterial supply to hand
RA and UA join in 2 arches
Superficial and deep palmar arches
Radial Artery Compression Devices
The most important bleeding
avoidance strategy?
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Femoral
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Radial