The Journal of invasive cardiology
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Guide catheter kinking and fracture is an uncommon complication of percutaneous coronary intervention and may require emergency surgical intervention if percutaneous retrieval fails. We present a case of guide catheter kinking and fracture during attempts to engage the left main coronary artery in a patient with marked iliac tortuosity. The retained guide catheter fragment was retrieved percutaneously by using a snare from the contralateral femoral artery and removing the "folded-over" catheter fragment through the contralateral arteriotomy.
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Randomized Controlled Trial Comparative Study
Randomized comparison of radial versus femoral approach for patients with STEMI undergoing early PCI following intravenous thrombolysis.
Early percutaneous coronary intervention (PCI) following thrombolysis may be beneficial in patients with ST-segment elevation myocardial infarction (STEMI) who were admitted at a non-PCI hospital. The aim of this study was to evaluate the safety and efficacy of the radial artery as a vascular route for early PCI following thrombolysis in patients with STEMI. ⋯ TRI for STEMI patients following intravenous thrombolysis was as safe and feasible as TFI, with a trend toward lower incidence of bleeding complications and vascular complications.
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Radial access is the preferred route for cardiac catheterization; however, small radial arterial diameters can make complex procedures difficult. The assessment of radial artery diameters prior to intervention may be beneficial for the interventional cardiologist. Our aim was to measure the diameter of radial arteries in a study sample from our population, and to analyze the feasibility of using larger sheaths for radial interventions. ⋯ Six Fr sheaths can be used in a significant proportion of our population. Careful selection of male patients with a larger BMI may help the interventionist in advance for planning a radial procedure with larger sheaths.
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Acute coronary artery obstruction at the time of device implantation is a recognized, albeit rare, complication of TAVI and is most frequently managed by emergency percutaneous intervention. This complication usually manifests with circulatory collapse due to compromising left ventricular ischemia and is most often observed immediately following valve deployment in the catheter laboratory or in theater. ⋯ Circulatory support was rapidly and effectively instituted with an automated non-invasive cardiac massage device, AutoPulse, that delivers continuous chest compressions. Successful emergency percutaneous intervention was then undertaken to the left main stem to displace a calcified nodule during automated external cardiac massage with the AutoPulse.
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The collateral perfusion via the hypertrophied internal thoracic arteries and rich anastomosis between the epigastric arteries reconstituting femoral artery are an important route in patients with peripheral vascular disease (chronic aortoiliac occlusion), providing blood flow to the lower extremities. Selective angiography of the internal thoracic artery plays a major role in the preoperative evaluation in patients with severe aortoiliac occlusive disease undergoing coronary bypass surgery and may prevent a major potential postoperative complication of acute lower extremity ischemia in these patients.