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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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Northwestern Memorial HospitalHealthy Transitions Fall ProgramOctober 7, 2013 Coronary Artery Disease: Diagnosis and Treatment Mark J. Ricciardi, MD Director, Interventional Cardiology and Cardiac Catheterization Northwestern Bluhm Cardiovascular Institute
Outline • Coronary artery disease (CAD) basics • Diagnosis of CAD • Cardiac Catheterization / Coronary Angiography • Treatment of CAD • Coronary Angioplasty / Stent • Past, present, future
Coronary Disease • Atherosclerosis • ‘Arteriosclerosis’ • Fatty buildup in lining of artery wall • Plaque • Impinges on flow • Reduces amount of blood and oxygen delivered to the heart muscle
CADthe goal… • is prevention • Primary prevention • Prevent early / sub-clinical stages • Heart healthy lifestyle • Starting in childhood • Medications • Targeted at high risk groups
Diagnosis of CAD • History • Symptoms • Angina
Diagnosis of CAD • History • Symptoms • Angina • Non-invasive imaging • Stress testing • provocation • CT angiogram • good, not great
Diagnosis of CAD • History • Symptoms • Angina • Non-invasive imaging • Stress testing • CT angiogram • Invasive imaging • Left heart catheterization / coronary angiography … the gold standard for Dx
Coronary AngiographyPurposes • Define coronary anatomy, and presence, absence, degree obstruction • Most commonly used to: • determine extent of CAD • assess feasibility and appropriateness of mechanical revascularization
Arterial access Femoral artery Most common access site since 1980s 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 Lower risk of significant bleeding No bed rest required
Arterial access Radial artery “Down side” -the learning curve
CAD Treatment • Secondary prevention • Lifestyle modification • Diet, exercise, tobacco cessation • Rx underlying risk factors • Aspirin and ‘statin’ medications • Anti-anginal medications • Beta blockers
Northwestern Memorial Hospital Cardiac Catheterization Center • Chicagoland’s First: • Coronary Stent (1990s) • Drug eluting stent (early 2000s)
Northwestern Memorial Hospital Cardiac Catheterization Center • Chicagoland’s First: • Coronary Stent (1990s) • Drug eluting stent (early 2000s) • Bio-absorbable stent (2013)
Next Generation Stents Bioabsorbable / dissolving stents In clinical trials at Northwestern
Conclusions • CAD • Sub-clinical plaque formation • Symptomatic CAD • Angina, heart attack • Non-invasive and invasive testing • CAD Treatment • Behavioral, pharmacologic, mechanical • NW big part of the past, present and future of CAD Rx
Questions? • http://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=angiog • http://www.scai.org/PatientEducation/default.aspx
Judkins Technique JL and JR catheters Melvin Judkins
Femoral Artery Hemostasis Perclose Suture-Mediated Closure System (Abbott Vascular) • Non-braided polyester suture • Automated knot tying • Closure of 5-8Fr. access sites • ‘pre-closure’
Transradial Angiography / InterventionAnatomy 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
Femoral Radial The most important bleeding avoidance strategy?