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Coronary angiography and
PCI
Samo Granda, Franjo Naji
Department of Cardiology
Clinical department of internal medicine
University clinical centre Maribor
Coronary arteries
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...
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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...
The procedure:
• patient conscious but slightly sedated
• patient in supine position on the table
• sterile preparation (vascular site,
equipment, operators...)
Femoral or radial access site
Radial artery approach Radial artery approach
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Radial artery approach Radial artery approach
Radial artery approach Radial artery approach
Radial artery approach Femoral artery approach
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The procedure:
• 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
J tipped Guidewire
The procedure:
• 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
The procedure:
• 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
The procedure:
• 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
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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
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The procedure:
• 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
The procedure:
• 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
The procedure:
• a diagnostic right coronary catheter is
removed from the coronary ostium
• a guidewire is introduced and catheter
removed
A real case:
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A real case:
A real case:
The procedure:
• 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
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Coronary wire accross the stenosis The procedure:
• 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
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PTCA PTCA
The procedure:
• 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 10-20 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
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Coronary stenting – final result Coronary stenting – final result
Other coronary procedures:
• 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
Bifurcation treatment
OCT and IVUS Complications of PCI:
• unsuccessful / incomplete revascularization
• coronary dissection
• coronary rupture
• stent thrombosis
• distal coronary embolization
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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!
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