Percutaneous coronary intervention: Difference between revisions
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| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: A<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | | colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: A<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | ||
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| bgcolor="LightGreen"|1. | | bgcolor="LightGreen"|1.[[Radial artery]] approach is recommended over the [[femoral artery]] access in [[patients]] with [[acute coronary syndromes]] | ||
([[acute coronary syndromes|ACS]]) undergoing [[PCI]] due to lower rate of death, [[Blood vessel|vascular]] and [[bleeding]] [[complications]]. | ([[acute coronary syndromes|ACS]]) undergoing [[PCI]] due to lower rate of death, [[Blood vessel|vascular]] and [[bleeding]] [[complications]]. | ||
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2. | 2.[[Radial artery]] approach is recommended over the [[femoral artery]] access in [[patients]] with [[Chronic stable angina|stable ischemic heart disease]] ([[Chronic stable angina|SIHD]]) undergoing [[PCI]] due to lower rate access site [[bleeding]] and [[Blood vessel|vascular]] [[complications]]. | ||
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Revision as of 07:43, 22 June 2022
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Percutaneous coronary intervention Microchapters |
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PCI Complications |
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PCI in Specific Patients |
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PCI in Specific Lesion Types |
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Percutaneous coronary intervention On the Web |
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American Roentgen Ray Society Images of Percutaneous coronary intervention |
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Directions to Hospitals Treating Percutaneous coronary intervention |
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Risk calculators and risk factors for Percutaneous coronary intervention |
For patient information, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shankar Kumar, M.B.B.S. [2]
Synonyms and keywords: PCI; balloon angioplasty; percutaneous transluminal coronary angioplasty; coronary angioplasty; coronary artery angioplasty; heart artery dilatation
Overview
Risk Stratification and Benefits of PCI
PCI Approaches
- Radial artery and femoral artery are two main methods to access the artery in percutaneous coronary intervention (PCI).[1]
- The rate of PCI through radial artery catheterization has been increased over the past decade and patients usually prefer this approach more that the femoral artery access.[2][3]
- The following are the advantages of radial artery compared to the femoral artery approach:[4]
- Earlier ambulation
- Lower rate of vascular complications
- Lower rate of bleeding complications
- Better cardiovascular outcomes
- It is recommended to evaluate the possibility of future need to radial artery for bypass grafting before using it for PCI. In cases that there is a high likelihood of future CABG, discussion with the patient and the cardiac surgeon is required.[1]
ACA 2021 Revascularization Guideline for PCI Approaches
| Class 1 Recommendation, Level of Evidence: A[1] |
| 1.Radial artery approach is recommended over the femoral artery access in patients with acute coronary syndromes
(ACS) undergoing PCI due to lower rate of death, vascular and bleeding complications.
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Preparation of the Patient for PCI
Equipment Used During PCI
Pharmacotherapy to Support PCI
Vascular Closure Devices
Post-PCI Management
Risk Reduction After PCI
Post-PCI Follow up
PCI Complications
Factors Associated with Complications | New or Enlarging Thrombus | Vessel Perforation | Dissection | Distal Embolization | Slow Flow | No-reflow | Abrupt Closure | Access Site Complications | Peri-procedure Bleeding | Intraprocedural Stent Thrombosis | Restenosis | Renal Failure | Thrombocytopenia | Late Acquired Stent Malapposition | Loss of Side Branch | Multiple Complications
PCI in Specific Patients
Cardiogenic Shock | Refractory Ventricular Arrhythmia | Severely Depressed Ventricular Function | Sole Remaining Conduit | Unprotected Left Main Patient | Adjuncts for High Risk PCI
PCI in Specific Lesion Types
Classification of the Lesion | The Calcified Lesion | The Ostial Lesion | The Angulated or Tortuous Lesion | The Bifurcation Lesion | The Long Lesion | The Bridge Lesion | Vasospasm | The Chronic Total Occlusion | The Left Internal Mammary Artery | Multivessel Disease | Distal Anastomotic Lesions | Left Main Intervention | The Thrombotic Lesion
Related Chapters
- Vascular closure devices
- Angioplasty
- Conscious sedation
- Preparation of the patient for diagnostic catheterization
- Technical aspects of the cardiac catheterization laboratory
- Obtaining venous and arterial access
- Equipment used in diagnostic catheterization
- Hemodynamic assessment in the cardiac catheterization laboratory
- Radiation safety
- Fractional flow reserve
- ↑ 1.0 1.1 1.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ Masoudi FA, Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC; et al. (2017). "Trends in U.S. Cardiovascular Care: 2016 Report From 4 ACC National Cardiovascular Data Registries". J Am Coll Cardiol. 69 (11): 1427–1450. doi:10.1016/j.jacc.2016.12.005. PMID 28025065.
- ↑ Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P; et al. (2011). "Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial". Lancet. 377 (9775): 1409–20. doi:10.1016/S0140-6736(11)60404-2. PMID 21470671.
- ↑ Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G; et al. (2016). "Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials". JACC Cardiovasc Interv. 9 (14): 1419–34. doi:10.1016/j.jcin.2016.04.014. PMID 27372195.