Table of contents
.
Introduction
- Two types of angiography
- Selective - engaging each coronary artery and injecting contrast dye into each
- Non-Selective - putting contrast dye into the aortic root to visualize coronaries
- Arterial Access
- Femoral (traditional)
- Radial (newer)
- Types of introducers for cardiac cath: (increasing in size)
- 5 Fr Slender
- 5 French
- 6 Fr Slender
- 6 French
- NOTE: Slender catheters have the same luminal diameter, but are smaller (can kink easier)
- NOTE: Usually if PCI is planned, go with a larger catheter (i.e. 6Fr), but some do PCI with 5 Fr.
- Types of catheters for angiography
- Universal Catheters (engaging both L and R coronaries)
- Tigg (available at UH)
- Also has side-holes to prevent complete occlusion
- Tiger
- Kimny
- Tigg (available at UH)
- Selective Catheters
- Judkins Right (JR)
- Judkins Left (JL)
- Amplaz R and L (AR, AL)
- Number after the catheter indicates the size of the curve on the end (i.e. JR-4 has a wider curve, JR-3 has a narrower curve).
- If you find that the JL4 catheter always ends up below the coronary osteum, use JL3.5 or 3
- Special Catheters
- IMA Catheter - For LIMA cannulation from the L-arm.
- PigTail Catheter - for LV and root shots (some have a bend on the end, others dont)
- Guiding Catheters
- aka Extra Backup (i.e. EBU catheters)
- These are for coronary wires, and stents
- They are thicker, wider, and curve from one side of aorta to another, which provides support for wires and stents.
- They are considered more dangerous because they are thick and stiff
- Universal Catheters (engaging both L and R coronaries)
- Types of wire:
- Large Wire
- J-tip 0.035'' guidewire
- Coronary Wire
- BMW
- etc..
- Large Wire
Technique - Radial Approach
- Most use the micropuncture kit that includes a puncture needle and a wire
- Ideal puncture location is below radial styloid (which is more proximal than art lines)
- Before the procedure ensure you check for dual arterial supply using methods:
- Allan Test
- Barbeau Test (Barbeau et al 2004) Am. Heart J.
- Put sat probe on thumb, occlude radial and ulnar, wait for sat waveform to flatten
- Then release ulnar artery and see if waveform recovers
- Responses grouped in types A-D
- A = normal waveform, B = slightly dampened, becomes normal in 2min
C = remains flat, pulsation comes back after 2 min. D = flat all the time - Don't use radial if Barbeau Class D
- Vasodilators Must Be Given (radial only)
- Verapamil 2.5-5mg +/- nitroglycerin 200mcg into sheath
- Anticoagulation must be given (radial only)
- heparin 70u/kg IV or bivalirudin if PCI
- Most catheters were made for femoral approach, so sometimes can be hard to use them
Engaging Coronaries
- Move wire and catheter into ascending aorta (can ask deep breath to facilitate lowering of heart)
- Do this in AP projection
- Engage in LAO
Cannulating Grafts
- A bit trickier because you don't know where they take off from
- Usually L-sided grafts are on the L-aorta and above L-main
- Usually R-sided grafts are on the R-aorta above R-main (check previous caths for clues, and use sternal wires as landmarks)
- Typically LIMAs are easier to cannulate from the L-radial approach (many attendings use L-radial and bring arm over the patient to work from the right side)
- Also easier to cannulate from the femoral arteries
Comments