BOOK
Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease E-Book
(2015)
Additional Information
Book Details
Abstract
Introducing Cardiovascular Intervention, a comprehensive companion volume to Braunwald’s Heart Disease. This medical reference book contains focused chapters on how to utilize cutting-edge interventional technologies, with an emphasis on the latest protocols and standards of care. Cardiovascular Intervention also includes late-breaking clinical trials, "Hot off the Press" commentary, and Focused Reviews that are relevant to interventional cardiology.
- View immersive videos from an online library of procedural clips located on Expert Consult.
- Remain abreast of the newest interventional techniques, including next-generation stents, invasive lesion assessment, and methods to tackle complex anatomy.
- Provide optimal patient care with help from easy-to-access information on the latest diagnostic and treatment advances, discussions on percutaneous approaches to structural heart disease, and new developments in treating heart valve disease.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Endsheet 2 | IFC2 | ||
| Cardiovascular Intervention | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| List of Contributors | vii | ||
| Foreword | xi | ||
| Preface | xiii | ||
| Acknowledgments | xv | ||
| Table Of Contents | xvii | ||
| Video Contents | xix | ||
| Look for These Other Titles in the Braunwald’s Heart Disease Family | xxiii | ||
| Braunwald’s Heart Disease Companions | xxiii | ||
| Braunwald’s Heart Disease Review and Assessment | xxv | ||
| Braunwald’s Heart Disease Imaging Companions | xxv | ||
| Coming Soon! | xxv | ||
| I Interventional Cardiology | 1 | ||
| 1 The Birth of Interventional Cardiology | 1 | ||
| The Innovator of Angioplasty | 1 | ||
| The First Peripheral Arterial Angioplasty | 2 | ||
| The Development of Coronary Angioplasty | 2 | ||
| Coronary Angioplasty Then and Now | 3 | ||
| Acute Angioplasty Failure | 3 | ||
| Mechanism of Balloon Angioplasty | 4 | ||
| Dissemination of Coronary Angioplasty | 4 | ||
| Andreas Grüntzig, the Man | 4 | ||
| Development of Interventional Cardiology and Minimally Invasive Surgery | 5 | ||
| Acknowledgment | 5 | ||
| References | 5 | ||
| 2 Guidelines and Appropriateness Criteria for Interventional Cardiology | 7 | ||
| Introduction | 7 | ||
| Practice Guidelines | 7 | ||
| Guideline Development | 7 | ||
| Guidelines for ST-Elevation Myocardial Infarction | 8 | ||
| Guidelines for Unstable Angina/Non–ST-Elevation MI | 10 | ||
| Guidelines for Stable Ischemic Heart Disease | 12 | ||
| Appropriateness Criteria | 13 | ||
| Development Process | 13 | ||
| Summary of Recommendations for Coronary Revascularization | 13 | ||
| Other Methods to Improve Quality | 17 | ||
| Performance Measures | 17 | ||
| Public Reporting | 18 | ||
| Putting Guidelines into Practice | 18 | ||
| Conclusions | 18 | ||
| References | 18 | ||
| 3 Vascular Access and Closure | 20 | ||
| Femoral Arterial Access | 20 | ||
| Introduction | 20 | ||
| Anatomic Considerations | 20 | ||
| Preprocedural Considerations | 21 | ||
| Procedure | 22 | ||
| Special Considerations | 22 | ||
| Using a Micropuncture Needle | 22 | ||
| Using a SmartNeedle Percutaneous Doppler Vascular Access Device | 23 | ||
| Using Ultrasound Guidance | 23 | ||
| Femoral Arterial Cannulation in a Challenging Patient Subgroup | 24 | ||
| Morbidly Obese Patients | 24 | ||
| Patients with Ilio-femoral Bypass Grafts | 24 | ||
| Patients with Calcified Femoral Artery | 25 | ||
| Postprocedure Care | 25 | ||
| Complications | 25 | ||
| Bleeding/Hematoma | 25 | ||
| Retroperitoneal Hemorrhage | 25 | ||
| Arteriovenous Fistula | 26 | ||
| Pseudoaneurysm | 27 | ||
| Artery Occlusion | 27 | ||
| Dissection | 27 | ||
| Femoral Neuropathy | 27 | ||
| Groin Site Infection | 28 | ||
| Femoral Arterial Access Site Closure | 30 | ||
| Introduction | 30 | ||
| Manual Compression | 30 | ||
| Mechanical Compression | 30 | ||
| Assisted Compression Devices/Topical Hemostasis Accelerators | 32 | ||
| Vascular Closure Device | 32 | ||
| Collagen-Plug-Based Devices—Angio-Seal | 34 | ||
| Collagen-Plug-Based Devices—Mynx | 35 | ||
| Suture-Mediated Closure Devices | 36 | ||
| Clip-Based Device—StarClose | 37 | ||
| Radial Arterial Access and Closure | 37 | ||
| Introduction | 37 | ||
| Anatomic Considerations | 39 | ||
| Preprocedural Considerations | 39 | ||
| Modified Allen Test | 39 | ||
| Barbeau Test | 40 | ||
| Procedural Considerations | 42 | ||
| Positioning | 43 | ||
| Conscious Sedation and Local Anesthesia | 43 | ||
| Technique | 43 | ||
| Closure and Postprocedural Care | 43 | ||
| Closure | 43 | ||
| Postprocedure Care | 45 | ||
| Complications and Challenges | 45 | ||
| Radial Artery Occlusion | 45 | ||
| Access Failure | 45 | ||
| Perforation | 45 | ||
| Hematoma | 47 | ||
| Compartment Syndrome | 47 | ||
| Radial Artery Pseudoaneurysm (Figure 3-34) | 47 | ||
| Radial Arteriovenous Fistula | 48 | ||
| Sterile Granuloma | 48 | ||
| Radial Artery Avulsion | 48 | ||
| Ulnar Arterial Access and Closure | 48 | ||
| Brachial Arterial Access and Closure | 49 | ||
| Introduction and Anatomy | 49 | ||
| II Coronary Artery Intervention | 115 | ||
| 8 Percutaneous Coronary Intervention for Unprotected Left Main Disease | 115 | ||
| Introduction | 115 | ||
| Randomized Controlled Trials | 115 | ||
| Metaanalyses | 117 | ||
| Ongoing Trials | 118 | ||
| Current Guidelines and Appropriate use Criteria | 118 | ||
| Scoring Algorithms | 119 | ||
| Impact of Stent Choice | 120 | ||
| In-Stent Restenosis | 120 | ||
| Disease Location: Ostial/mid-Shaft versus Distal LM | 120 | ||
| One-Stent versus Two-Stent Approach for LM Bifurcation Disease | 121 | ||
| Two-Stent Techniques | 123 | ||
| Dedicated Bifurcation Stents | 123 | ||
| Importance of Final Kissing Balloon Inflation | 123 | ||
| Role of Imaging | 124 | ||
| Intravascular Ultrasound | 124 | ||
| Fractional Flow Reserve | 125 | ||
| Myocardial Infarction due to LM Thrombosis | 125 | ||
| Hemodynamic Support | 126 | ||
| Dual Antiplatelet Therapy Selection and Duration | 126 | ||
| Follow-Up after Left Main PCI | 126 | ||
| Left Main Bifurcation PCI Techniques | 126 | ||
| Provisional Stent Technique (Figure 8-6 and Video 8-1) | 126 | ||
| Two-Stent Techniques | 128 | ||
| Description of Techniques | 128 | ||
| Culotte Technique (Figure 8-7 and Video 8-2) | 128 | ||
| Crush Techniques (Figure 8-8 and Video 8-3) | 129 | ||
| T-Stent Techniques (Figure 8-10 and Video 8-5) | 130 | ||
| V-Stent Technique (Figure 8-11 and Video 8-6) | 130 | ||
| Ostial LM PCI | 131 | ||
| Conclusions | 131 | ||
| References | 136 | ||
| 9 Chronic Total Coronary Occlusions: | 138 | ||
| Introduction | 138 | ||
| Anatomic Considerations | 138 | ||
| Histopathology of CTOs | 139 | ||
| Collaterals and CTOs | 139 | ||
| Target Vessel | 140 | ||
| Indications | 140 | ||
| Angina and Quality of Life | 141 | ||
| Improvement in Left Ventricular Dysfunction | 142 | ||
| Reduction in Arrhythmic Events | 143 | ||
| Improved Tolerance of Ischemic Events | 143 | ||
| Survival and Completeness of Revascularization | 144 | ||
| Procedural Outcomes and Fundamentals | 144 | ||
| Predictors of Procedural Outcome | 144 | ||
| Vascular Access, Equipment Selection, and Angiography | 145 | ||
| Guidewires and Microcatheters | 146 | ||
| Procedural Antithrombotic Therapy | 146 | ||
| Technical Strategies | 147 | ||
| Traditional Antegrade Techniques | 147 | ||
| Antegrade Device-Assisted Dissection Reentry Technique | 147 | ||
| Retrograde Techniques: CART and Reverse CART | 147 | ||
| Hybrid Technique | 149 | ||
| Imaging: Computed Tomographic Angiography and Intravascular Ultrasound | 150 | ||
| Stent Selection for CTO Revascularization | 150 | ||
| Clinical Rationale for Drug-Eluting Stents in Percutaneous Revascularization of Coronary Occlusions | 150 | ||
| Contemporary DES Trials in CTO Revascularization | 151 | ||
| Limitations | 152 | ||
| CTO Complications | 152 | ||
| Conclusions | 152 | ||
| References | 153 | ||
| 10 Bifurcations | 155 | ||
| Introduction | 155 | ||
| Simplified Guidelines After 10 Years of Bifurcation Studies | 156 | ||
| Provisional Approach Is the Default Strategy | 156 | ||
| Two Stents Can Be Selectively Implanted As Intention to Treat or Crossover from Provisional | 158 | ||
| Residual SB Stenosis After the Provisional Approach Is Often Not Significant | 159 | ||
| Kissing Balloon Inflation or High-Pressure Individual (SB & MB) Postdilatation Should Always Be Used When Implanting Two Stents and Optionally When Implanting One Stent | 160 | ||
| Optimal Technique Is a Must, Especially When Two Stents Have Been Implanted | 162 | ||
| Stent Thrombosis After Bifurcation PCI | 162 | ||
| An Individualized Approach to Bifurcations | 162 | ||
| Technical Aspects of Bifurcation PCI | 163 | ||
| General Aspects | 163 | ||
| Guide Catheter | 163 | ||
| Vascular Access | 163 | ||
| Wiring Both Branches of the Bifurcation and Jailed Guidewires | 163 | ||
| Difficult SB Access | 164 | ||
| Provisional Approach | 164 | ||
| Proximal Optimization Technique (POT) | 165 | ||
| Final Kissing Balloon Inflation (FKBI) | 165 | ||
| Technical Tips for Provisional Approach | 165 | ||
| Crossover to Double Stenting from a Provisional Approach | 165 | ||
| T Technique | 166 | ||
| T-Stenting and Small Protrusion (TAP) | 166 | ||
| Reverse Crush | 166 | ||
| Provisional Culotte | 167 | ||
| Elective Double Stenting | 167 | ||
| Selecting a Double Stenting Technique | 168 | ||
| Double Stenting Technique Description | 171 | ||
| The Culotte Technique | 171 | ||
| The Minicrush Technique (SB Stent Crushed by the MB Stent) | 174 | ||
| Double-Kissing Minicrush (DK Crush) | 177 | ||
| T and Modified T Techniques | 178 | ||
| Modified T Technique | 178 | ||
| The V and the Simultaneous Kissing Stent (SKS) Techniques | 178 | ||
| Final Kissing Inflation (FKBI) after Double Stenting | 180 | ||
| Difficult Access to the SB or MB after Stenting | 180 | ||
| Ancillary Devices and Procedures | 180 | ||
| Intravascular Ultrasound (IVUS) | 180 | ||
| Lesion Preparation: Role of Debulking | 181 | ||
| Drug-Eluting Balloons in Bifurcations | 181 | ||
| Dedicated Bifurcation Stents | 181 | ||
| Bioresorbable Scaffolds (BRS) in Bifurcations | 182 | ||
| Conclusions | 182 | ||
| References | 182 | ||
| 11 Bypass Graft Interventions | 184 | ||
| Introduction | 184 | ||
| Epidemiology | 184 | ||
| Indications for Bypass Graft Interventions | 184 | ||
| Distal Embolization and Embolic Protection Devices | 184 | ||
| SVG Stenting | 191 | ||
| Adjunctive Pharmacotherapy | 191 | ||
| Technical Aspects of SVG PCI | 192 | ||
| Intravascular Imaging | 192 | ||
| SVG Engagement | 192 | ||
| Acutely Occluded SVGs | 193 | ||
| Chronically Occluded SVGs | 193 | ||
| Intermediate SVG Lesions | 193 | ||
| SVG PCI Complications | 193 | ||
| Arterial Graft Interventions | 193 | ||
| Conclusions | 196 | ||
| Acknowledgment | 196 | ||
| References | 196 | ||
| 12 Calcified Lesions | 199 | ||
| Introduction | 199 | ||
| Percutaneous Transluminal Rotational Atherectomy | 199 | ||
| Procedural Details | 199 | ||
| Clinical Studies of Rotational Atherectomy | 201 | ||
| Summary | 201 | ||
| Orbital Atherectomy | 202 | ||
| Procedural Details | 202 | ||
| Clinical Studies of Orbital Atherectomy | 202 | ||
| Summary | 203 | ||
| Scoring Balloon Angioplasty (SBA) | 203 | ||
| Clinical Studies of Scoring Balloon Angioplasty | 204 | ||
| Summary | 205 | ||
| Excimer Laser Atherectomy | 205 | ||
| Procedural Details | 205 | ||
| Clinical Studies of Excimer Laser Atherectomy | 206 | ||
| Summary | 206 | ||
| Conclusions | 206 | ||
| References | 207 | ||
| 13 Treatment of In-Stent Restenosis | 209 | ||
| Introduction | 209 | ||
| Mechanisms of In-Stent Restenosis | 210 | ||
| Balloon Angioplasty | 210 | ||
| Plaque Debulking With Atherectomy | 212 | ||
| Cutting and Scoring Balloon Angioplasty | 213 | ||
| Vascular Brachytherapy | 214 | ||
| Bare-metal Stenting | 215 | ||
| Drug-Eluting Stenting | 215 | ||
| Restenosis Within Bare-metal Stents | 216 | ||
| Restenosis Within Drug-Eluting Stents | 216 | ||
| Bioresorbable Stents | 217 | ||
| Drug-Coated Balloon Angioplasty | 217 | ||
| Restenosis Within Bare-Metal Stents | 217 | ||
| Restenosis Within Drug-Eluting Stents | 218 | ||
| Coronary Bypass Surgery | 219 | ||
| Role of Intravascular Imaging | 219 | ||
| Additional Considerations | 219 | ||
| Bioresorbable Stent Failure | 219 | ||
| Conclusions | 220 | ||
| References | 221 | ||
| 14 Management of Thrombotic Lesions | 223 | ||
| Introduction | 223 | ||
| Stent Thrombosis | 223 | ||
| Pharmacological Strategies to Improve Myocardial Perfusion | 223 | ||
| Mechanical Strategies to Improve Myocardial Perfusion | 224 | ||
| Currently Approved Devices | 224 | ||
| Case | 225 | ||
| Potentially Useful Devices | 225 | ||
| Devices That Are Not Used | 227 | ||
| Clinical Trial Data | 227 | ||
| Aspiration Thrombectomy | 227 | ||
| Rheolytic Thrombectomy and Distal Embolic Protection | 227 | ||
| Infusion Catheter | 227 | ||
| Guideline Recommendations | 228 | ||
| Conclusions | 228 | ||
| References | 228 | ||
| 15 Fractional Flow Reserve | 229 | ||
| Introduction | 229 | ||
| Rationale for In-Lab Coronary Physiologic Measurements | 229 | ||
| Derivation of Fractional Flow Reserve from Coronary Pressure Measurements | 231 | ||
| Coronary Flow Reserve versus Fractional Flow Reserve | 232 | ||
| Fractional Flow Reserve and Myocardial Bed Size | 232 | ||
| Techniques of Intracoronary Pressure Sensor Wire Measurement | 233 | ||
| Pharmacologic Coronary Hyperemia | 234 | ||
| Adenosine | 234 | ||
| Regadenoson | 234 | ||
| Alternative Hyperemic Agents | 235 | ||
| Precautions and Pitfalls of Fractional Flow Reserve | 235 | ||
| Safety of Intracoronary Sensor Wire Measurements | 236 | ||
| Validation and Threshold of Ischemia | 236 | ||
| Use of Fractional Flow Reserve for Specific Angiographic Subsets | 236 | ||
| The Intermediate Coronary Lesion | 236 | ||
| Fractional Flow Reserve in Multivessel Disease | 237 | ||
| Fractional Flow Reserve After Percutaneous Coronary Intervention | 239 | ||
| Left Main Stenosis | 239 | ||
| Complex Left Main Lesion Assessment (LM Plus Downstream Lesions) with Fractional Flow Reserve | 239 | ||
| Fractional Flow Reserve and Small-Vessel Disease | 240 | ||
| Serial (Multiple) Lesions in a Single Vessel | 240 | ||
| Practical Technique of Serial Lesion Assessment | 242 | ||
| Diffuse Coronary Disease | 242 | ||
| Ostial and Side Branch Lesions | 242 | ||
| Saphenous Vein Graft Lesions | 242 | ||
| Fractional Flow Reserve in Acute Coronary Syndrome | 245 | ||
| Intravascular Ultrasound and Fractional Flow Reserve in Lesion Assessment | 245 | ||
| Fractional Flow Reserve and Intravascular Ultrasound Comparisons for Non–Left Main Coronary Artery Stenosis | 247 | ||
| Assessing Collateral Flow | 247 | ||
| Index of Microcirculatory Resistance | 248 | ||
| Economics of Physiologic Guided Interventions | 248 | ||
| Conclusions | 249 | ||
| References | 250 | ||
| 16 Intravascular Ultrasound Imaging | 252 | ||
| Background and Limitations of Angiography | 252 | ||
| IVUS Imaging, Basic Image, and Measurements | 253 | ||
| Guidelines for Use and Appropriate Indications | 256 | ||
| Diagnostic Applications | 256 | ||
| Ambiguous Angiograms and Indeterminate Coronary Lesions | 256 | ||
| Evaluation of the Left Main Coronary Artery | 258 | ||
| Evaluation of Transplant Vasculopathy | 260 | ||
| Interventional Applications | 260 | ||
| Vessel Sizing | 260 | ||
| IVUS Imaging in Coronary Stenting | 260 | ||
| Bare-Metal Stents | 261 | ||
| Drug-Eluting Stents | 262 | ||
| Strut Malapposition | 264 | ||
| Management of Stent Restenosis | 265 | ||
| Assessment of Complications After Intervention | 265 | ||
| Advanced Applications of IVUS Imaging in Chronic Total Occlusion Angioplasty | 267 | ||
| IVUS Imaging in the Peripheral Arterial System | 267 | ||
| Research Applications—Progression/Regression Trials | 269 | ||
| Advancing IVUS Technologies and Future Directions | 270 | ||
| IVUS-Derived Virtual Histology | 270 | ||
| IVUS and Near Infrared Spectroscopy (NIRS) | 272 | ||
| IVUS and OCT Imaging | 272 | ||
| Future Directions | 273 | ||
| Conclusions | 274 | ||
| Acknowledgment | 274 | ||
| References | 274 | ||
| 17 Optical Coherence Tomography | 276 | ||
| Introduction | 276 | ||
| Physics of Optical Coherence Tomography | 276 | ||
| Image Acquisition by Optical Coherence Tomography | 277 | ||
| Time Domain Optical Coherence Tomography | 277 | ||
| Frequency Domain Optical Coherence Tomography | 278 | ||
| Potential Risks and Complications | 278 | ||
| Evaluation of Coronary Pathology | 278 | ||
| Normal Artery | 278 | ||
| Lipid Plaque | 279 | ||
| Fibrous and Fibrocalcific Plaque | 279 | ||
| Intraluminal and Intramural Pathology Seen by Optical Coherence Tomography | 279 | ||
| Macrophages | 279 | ||
| Cholesterol Crystal | 280 | ||
| Microchannels | 280 | ||
| Thrombus | 280 | ||
| Others | 280 | ||
| Thin-Cap Fibroatheroma | 280 | ||
| Pitfalls of Image Interpretation | 281 | ||
| Optical Coherence Tomography Imaging Artifacts | 281 | ||
| Assessment of Coronary Plaque Characteristics | 282 | ||
| Clinical Presentations and Plaque Morphology | 282 | ||
| Etiology of Acute Coronary Syndrome | 282 | ||
| Acute Myocardial Infarction at Rest versus with Exercise | 283 | ||
| Role of Optical Coherence Tomography In Percutaneous Coronary Intervention | 283 | ||
| Pre-stent Deployment | 283 | ||
| Immediate Post-stent Deployment | 284 | ||
| Bifurcation Intervention | 285 | ||
| Clinical Benefit of Optical Coherence Tomography–Guided Percutaneous Coronary Intervention | 285 | ||
| Late Stent Evaluation | 285 | ||
| Assessment of Non–Coronary Artery Pathology | 287 | ||
| Pulmonary Hypertension | 287 | ||
| Peripheral Vascular Disease | 287 | ||
| Transplant Vasculopathy | 287 | ||
| Future Directions | 287 | ||
| Multimodality Systems | 287 | ||
| Three-Dimensional Optical Coherence Tomography | 287 | ||
| Micro-optical Optical Coherence Tomography | 287 | ||
| Conclusion | 288 | ||
| References | 288 | ||
| III Peripheral Artery Intervention | 291 | ||
| 18 Intervention for Lower Extremity Arterial Disease | 291 | ||
| Clinical Assessment | 291 | ||
| Causes of Peripheral Artery Disease | 291 | ||
| Acute Limb Ischemia | 291 | ||
| Chronic Limb Ischemia | 293 | ||
| Physical Exam | 293 | ||
| Physiological Tests | 293 | ||
| Arterial Imaging | 293 | ||
| Percutaneous Revascularization Tools | 294 | ||
| Approach and Access | 294 | ||
| Guides and Sheaths | 295 | ||
| Wires | 297 | ||
| Anticoagulation | 297 | ||
| Reentry Devices | 297 | ||
| Other Chronic Total Occlusion (CTO) Devices | 299 | ||
| Balloon Angioplasty | 300 | ||
| Drug-Eluting Balloons | 301 | ||
| Stents | 301 | ||
| Covered Stents | 302 | ||
| Drug-Eluting Stents | 302 | ||
| Atherectomy | 302 | ||
| Other Plaque-Modifying Technologies | 303 | ||
| Brachytherapy | 304 | ||
| Catheter-Based Thrombolysis | 304 | ||
| Intravascular Imaging | 305 | ||
| Interventions in Specific Arteries | 308 | ||
| Aorto-iliac Interventions | 308 | ||
| Superficial Femoral Artery | 309 | ||
| Popliteal Artery | 309 | ||
| Tibial Arteries | 310 | ||
| Venous and Prosthetic Graft Interventions | 310 | ||
| Conclusions | 310 | ||
| References | 312 | ||
| 19 Upper Extremity Intervention | 314 | ||
| Introduction | 314 | ||
| Diagnosis and Clinical Syndromes | 314 | ||
| Treatment | 315 | ||
| Surgical Revascularization | 315 | ||
| Endovascular Therapy | 316 | ||
| Interventional Technique | 316 | ||
| Conclusions | 318 | ||
| References | 319 | ||
| 20 Renal Artery Intervention: | 321 | ||
| Introduction | 321 | ||
| Diagnosis | 321 | ||
| Screening for Renal Artery Stenosis | 321 | ||
| Duplex Ultrasonography | 321 | ||
| Resistive Index | 322 | ||
| Noninvasive Angiography | 322 | ||
| Invasive Angiography | 323 | ||
| Translesional Pressure Gradients | 323 | ||
| TIMI Frame Count | 323 | ||
| Renal Artery Intervention | 323 | ||
| Technique for Renal Artery Intervention | 324 | ||
| Renal Artery Atherosclerotic Lesions | 324 | ||
| Fibromuscular Dysplasia | 325 | ||
| Procedural Complications | 325 | ||
| Embolus Protection Devices | 325 | ||
| Radial Artery Access | 325 | ||
| Renal Artery In-Stent Restenosis | 326 | ||
| Asymptomatic Renal Artery Stenosis | 326 | ||
| Renovascular Hypertension | 326 | ||
| Clinical Characteristics | 326 | ||
| Prevalence | 326 | ||
| Epidemiology | 327 | ||
| IV Cerebrovascular Intervention | 377 | ||
| 24 Carotid and Vertebral Intervention | 377 | ||
| Carotid Intervention | 377 | ||
| The Data | 377 | ||
| The Procedure | 382 | ||
| Lesion Considerations | 385 | ||
| Access | 386 | ||
| Embolic Protection | 388 | ||
| Stent | 389 | ||
| Balloon Dilation | 391 | ||
| Hemodynamic Management | 392 | ||
| Neurological Management | 393 | ||
| Pharmacology | 394 | ||
| Conclusions | 394 | ||
| References | 394 | ||
| 25 Intracranial Intervention and Acute Stroke | 396 | ||
| Introduction | 396 | ||
| Cerebrovascular Disease | 396 | ||
| Epidemiology | 396 | ||
| Clinical Manifestations | 396 | ||
| Diagnostic Evaluation | 397 | ||
| The Cerebral Vasculature | 397 | ||
| Acute Ischemic Stroke Treatment | 397 | ||
| Techniques | 399 | ||
| Intraarterial Thrombolysis | 399 | ||
| Combined IV/IA Thrombolysis | 400 | ||
| Mechanical Embolectomy | 400 | ||
| Balloon Angioplasty and Stenting | 402 | ||
| Clinical Outcomes | 402 | ||
| Peri-procedural Management | 404 | ||
| Ischemic Stroke Prevention | 404 | ||
| Intracranial Angioplasty and Stenting | 404 | ||
| Indications and Patient Selection | 404 | ||
| Clinical Manifestation | 405 | ||
| Techniques | 405 | ||
| Clinical Outcomes | 407 | ||
| Conclusions | 408 | ||
| References | 408 | ||
| V Venous Intervention | 411 | ||
| 26 Interventional Management of Lower Extremity Deep Vein Thrombosis and Pulmonary Embolism | 411 | ||
| Introduction | 411 | ||
| Section 1: Lower Extremity Deep Vein Thrombosis | 411 | ||
| Acute Deep Vein Thrombosis | 411 | ||
| Epidemiology and Pulmonary Embolus Prevention | 411 | ||
| IVC Filters | 411 | ||
| The Post-Thrombotic Syndrome | 412 | ||
| Preventing the Post-Thrombotic Syndrome: Beyond Anticoagulation | 413 | ||
| Endovascular Thrombus Removal Techniques | 413 | ||
| Patient Selection (Table 26-1) | 415 | ||
| Outcomes and Data (Table 26-2) | 415 | ||
| Chronic Deep Vein Thrombosis | 415 | ||
| Patient Workup | 415 | ||
| Noninterventional Management of PTS | 416 | ||
| Endovascular Intervention in the Setting of Established PTS | 416 | ||
| Interventional Techniques to Recanalize Post-Thrombotic Deep Veins | 416 | ||
| Complications and Outcomes | 418 | ||
| Section 2: Acute Pulmonary Embolism | 419 | ||
| Epidemiology and Classification | 419 | ||
| Treatment Escalation for Massive Pulmonary Embolism | 419 | ||
| Treatment Escalation for Submassive Pulmonary Embolism | 420 | ||
| Patient Follow-Up | 420 | ||
| Conclusions | 421 | ||
| References | 421 | ||
| 27 Management of Chronic Venous Insufficiency | 423 | ||
| Epidemiology and Risk Factors of Chronic Venous Disease | 423 | ||
| Venous Anatomy and Physiology | 424 | ||
| Superficial Veins of the Lower Limb | 424 | ||
| Great Saphenous Vein | 424 | ||
| Anterior Accessory Saphenous Vein | 425 | ||
| Posterior Accessory Saphenous Vein | 425 | ||
| Small Saphenous Vein (SSV) | 425 | ||
| Perforators of the Lower Limb | 426 | ||
| Deep Venous System | 427 | ||
| Physiology of the Venous System | 428 | ||
| Etiology and Pathophysiology of Chronic Venous Insufficiency | 428 | ||
| Evaluation and Classification of the Patient with Chronic Venous Insufficiency | 429 | ||
| Anatomic and Physiologic Testing of Chronic Venous Insufficiency | 430 | ||
| Duplex Venous Ultrasound of the Lower Limb | 430 | ||
| Plethysmography | 432 | ||
| Treatment of Superficial Chronic Venous Insufficiency | 432 | ||
| Compression Therapy | 433 | ||
| Endovascular Heat Ablative Therapies | 433 | ||
| Endovascular Laser Ablation | 434 | ||
| Endovascular Radiofrequency Ablation | 434 | ||
| Steam Ablation | 435 | ||
| Nonthermal Ablative Therapies | 435 | ||
| Sclerotherapy | 435 | ||
| Catheter-Assisted Balloon Sclerotherapy | 436 | ||
| ClariVein or Mechanochemical Endovenous Ablation | 436 | ||
| Cyanoacrylate Adhesive | 437 | ||
| Phlebectomy | 437 | ||
| Surgical Vein Stripping | 437 | ||
| Pharmacologic Management of Chronic Venous Insufficiency | 437 | ||
| Endovascular Management of Venous Ulcerations | 438 | ||
| Deep Venous Valves | 438 | ||
| Conclusions | 439 | ||
| References | 439 | ||
| 28 Hemodialysis Access Intervention | 442 | ||
| Introduction | 442 | ||
| Epidemiology and Prevalence of Stage V Kidney Disease | 442 | ||
| Survival | 442 | ||
| Hemodialysis | 442 | ||
| Vascular Anatomy | 442 | ||
| Nomenclature | 442 | ||
| Autogenous Arteriovenous Accesses | 442 | ||
| Prosthetic Arteriovenous Accesses | 443 | ||
| Anatomic Variants | 443 | ||
| Pathogenesis of Access Failure | 444 | ||
| Failure to Mature | 444 | ||
| Stenosis Development in Mature Accesses, with or without Thrombosis | 444 | ||
| Diagnostic Evaluation | 445 | ||
| Monitoring | 445 | ||
| Surveillance | 445 | ||
| Diagnostic Testing | 445 | ||
| Catheter-Based Treatment of Failing Accesses | 445 | ||
| Indications | 445 | ||
| 4-Step Procedure for Thrombosed Accesses | 446 | ||
| Thrombectomy | 446 | ||
| Angioplasty, Stenting, or Stent-Grafting of Stenosis | 447 | ||
| Fogarty Embolectomy | 447 | ||
| Central Venous Angiography | 447 | ||
| Outcomes | 448 | ||
| Success Rates | 448 | ||
| Complications | 448 | ||
| Newer Approaches | 448 | ||
| Stent Grafts | 448 | ||
| Interventional Nephrology | 448 | ||
| Pre-emptive Angiography | 449 | ||
| Salvage of Hypoplastic Fistulas | 449 | ||
| Conclusions | 449 | ||
| References | 449 | ||
| VI Structural Heart Intervention | 451 | ||
| 29 Aortic Valvuloplasty and Transcatheter Aortic Valve Replacement | 451 | ||
| Introduction | 451 | ||
| Balloon Aortic Valvuloplasty | 451 | ||
| Procedural Considerations | 451 | ||
| Outcomes | 452 | ||
| Indications | 452 | ||
| Next Generation BAV Devices | 453 | ||
| Transcatheter Aortic Valve Replacement (Implantation)— General Concepts | 453 | ||
| Historical Perspectives and Unmet Clinical Need | 453 | ||
| Clinical Indications | 454 | ||
| Heart Team Model and Risk Assessment | 454 | ||
| Anatomic Screening and Need for Multimodality Imaging | 454 | ||
| Procedural Considerations | 455 | ||
| Balloon Expandable Valves | 455 | ||
| Technology Overview and Early Access Approaches | 455 | ||
| Procedural Details for Sapien or Sapien XT Implantation | 456 | ||
| Alternative Access Approaches | 456 | ||
| Early Feasibility Trials | 458 | ||
| SOURCE and Other Registries | 458 | ||
| The PARTNER Trial | 461 | ||
| Self-Expanding Valves | 467 | ||
| Technology Overview | 467 | ||
| Procedural Details for CoreValve Implantation | 468 | ||
| Alternative Access Approaches | 468 | ||
| Overview of Registry Data and ADVANCE | 469 | ||
| CoreValve US Pivotal Trial | 469 | ||
| “Real-World” Registries and Other Studies (Choice and TVT Registry) | 471 | ||
| New Clinical Indications | 472 | ||
| Bioprosthetic Valve Failure | 472 | ||
| Moderate-Risk Patients | 473 | ||
| TAVR for Bicuspid Aortic Valve | 473 | ||
| TAVR for Native Aortic Valve Regurgitation | 473 | ||
| Complications of TAVR | 474 | ||
| Stroke | 474 | ||
| Paravalvular Regurgitation | 474 | ||
| Conduction Abnormalities and Arrhythmias | 475 | ||
| Vascular Complications and Bleeding | 476 | ||
| Other Less Frequent Complications | 476 | ||
| New TAVR Devices | 477 | ||
| Overview | 477 | ||
| Self-Expanding TAVR Systems | 477 | ||
| Other TAVR Concepts | 477 | ||
| Future Directions | 478 | ||
| Conclusions | 478 | ||
| References | 478 | ||
| 30 Transcatheter Mitral Valve Intervention | 482 | ||
| Section I: Mitral Stenosis | 482 | ||
| Introduction | 482 | ||
| Normal Mitral Valve Anatomy | 482 | ||
| Mitral Valve Disease States: Mitral Stenosis | 482 | ||
| Etiologies of Mitral Stenosis | 482 | ||
| Pathology of Rheumatic Mitral Stenosis | 483 | ||
| Pathophysiology of Rheumatic Mitral Stenosis | 483 | ||
| Clinical Presentation of Mitral Stenosis | 483 | ||
| Clinical Manifestations | 483 | ||
| Clinical Assessment | 484 | ||
| History and Physical Examination | 484 | ||
| Clinical Assessment with Diagnostic Tools | 484 | ||
| Echocardiography | 484 | ||
| Cardiac Catheterization and Angiography | 485 | ||
| Management of Mitral Stenosis | 485 | ||
| Medical Therapy for Mitral Stenosis | 485 | ||
| Catheter-Based Treatment of Mitral Stenosis | 487 | ||
| Indications for Catheter-Based Treatment | 487 | ||
| Patient Selection | 487 | ||
| Procedure | 487 | ||
| Transseptal Catheterization | 487 | ||
| Inoue Technique | 489 | ||
| Double Balloon Technique | 490 | ||
| Results | 490 | ||
| Procedural Imaging | 491 | ||
| Special Considerations—Pregnancy | 491 | ||
| Section II: Mitral Regurgitation | 491 | ||
| Pathophysiology | 491 | ||
| Rationale for Transcatheter Therapy | 491 | ||
| Leaflet Repair with the MitraClip Device | 491 | ||
| Indirect Annuloplasty | 493 | ||
| Direct Annuloplasty and Left Ventricular Remodeling Techniques | 494 | ||
| Transcatheter Mitral Valve Replacement | 495 | ||
| Conclusions | 496 | ||
| References | 497 | ||
| 31 Hypertrophic Cardiomyopathy | 498 | ||
| Introduction and Epidemiology | 498 | ||
| Hallmarks and Differential Diagnosis | 498 | ||
| Natural Course of Disease and Clinical Presentation | 499 | ||
| Pathophysiology | 499 | ||
| Left Ventricular Outflow Tract Obstruction | 499 | ||
| Diastolic Dysfunction | 501 | ||
| Myocardial Ischemia | 501 | ||
| Autonomic Dysfunction | 501 | ||
| Mitral Regurgitation | 502 | ||
| Myocardial Fibrosis | 503 | ||
| Genetics and Role of Genetic Testing | 503 | ||
| Diagnosis | 504 | ||
| Echocardiography | 504 | ||
| Electrocardiography | 505 | ||
| Stress Testing | 505 | ||
| Cardiac Magnetic Resonance Imaging | 505 | ||
| Invasive Hemodynamic Assessment | 505 | ||
| Management of HCM | 507 | ||
| Asymptomatic Patients | 507 | ||
| Symptomatic Patients | 507 | ||
| Medical Management | 507 | ||
| Beta-Blockers | 507 | ||
| Calcium Channel Blockers | 507 | ||
| Disopyramide | 508 | ||
| Amiodarone | 508 | ||
| Other Agents | 508 | ||
| Invasive Management | 508 | ||
| Septal Myectomy | 509 | ||
| Patient Selection. | 509 | ||
| Early Results. | 509 | ||
| Late Results. | 509 | ||
| Complications. | 510 | ||
| Important Considerations. | 510 | ||
| Alcohol Septal Ablation | 510 | ||
| Patient Selection. | 510 | ||
| Procedural Technique (Video 31-1). | 510 | ||
| Results. | 513 | ||
| Complications. | 514 | ||
| Comparison of Alcohol Septal Ablation and Septal Myectomy | 514 | ||
| Role of Dual Chamber Pacing | 514 | ||
| Management of Atrial Fibrillation | 514 | ||
| Management of Systolic Dysfunction | 515 | ||
| Role of Heart Transplantation | 515 | ||
| Prevention of Sudden Cardiac Death | 515 | ||
| Participation in Competitive Sports | 515 | ||
| Role of ICD Implantation | 516 | ||
| Conclusions | 516 | ||
| References | 516 | ||
| 32 Patent Foramen Ovale, Atrial Septal Defect, Left Atrial Appendage, and Ventricular Septal Defect Closure | 519 | ||
| Patent Foramen Ovale | 519 | ||
| Introduction | 519 | ||
| Developmental Anatomy of the Atrial Septum (Figure 32-1) | 519 | ||
| Clinical Presentation | 520 | ||
| Diagnosis | 521 | ||
| Management | 521 | ||
| Medical Therapy | 521 | ||
| Transcatheter Patent Foramen Ovale Closure | 522 | ||
| Randomized Trials of Patent Foramen Ovale Closure for Cryptogenic Stroke | 522 | ||
| Indications for Transcatheter Patent Foramen Ovale Closure | 523 | ||
| Devices | 523 | ||
| Amplatzer Devices | 523 | ||
| Helex Device | 524 | ||
| Procedural Details | 524 | ||
| Postprocedure Care | 526 | ||
| Complications | 526 | ||
| ASD Closure | 526 | ||
| Introduction | 526 | ||
| Anatomy | 526 | ||
| Pathophysiology | 527 | ||
| Clinical Presentation | 527 | ||
| Diagnosis | 527 | ||
| Cardiac Catheterization | 527 | ||
| Management and Indications for Atrial Septal Defect Closure | 527 | ||
| Devices for Atrial Septal Defect Closure | 528 | ||
| Procedural Details | 529 | ||
| Postprocedure Care | 530 | ||
| Large Atrial Septal Defect with Deficient Rims | 530 | ||
| Multiple or Fenestrated Defects | 531 | ||
| Complications | 531 | ||
| Clinical Trial Data | 532 | ||
| Left Atrial Appendage Closure | 532 | ||
| Introduction | 532 | ||
| Medical Therapy for Stroke Prevention in Atrial Fibrillation | 532 | ||
| Left Atrial Appendage Anatomy | 532 | ||
| Surgical Left Atrial Appendage Exclusion | 532 | ||
| Percutaneous Left Atrial Appendage Closure | 532 | ||
| Imaging for Left Atrial Appendage Closure | 532 | ||
| PLAATO Device | 533 | ||
| Watchman Device | 533 | ||
| Procedure | 533 | ||
| Data for Watchman Device | 534 | ||
| Amplatzer Cardiac Plug | 534 | ||
| Data for Amplatzer Cardiac Plug Device | 534 | ||
| LARIAT Device | 535 | ||
| Next Generation Left Atrial Appendage Closure Devices | 535 | ||
| Watchman Generation 5 | 535 | ||
| Amulet | 535 | ||
| Coherex | 535 | ||
| Ventricular Septal Defect | 535 | ||
| Introduction | 535 | ||
| Anatomy | 535 | ||
| Pathophysiology | 536 | ||
| Clinical Presentation | 536 | ||
| Diagnosis | 536 | ||
| Management and Indications for Ventricular Septal Defect Closure | 536 | ||
| Devices for Transcatheter Ventricular Septal Defect Closure | 537 | ||
| Contraindications for Closure (Muscular Ventricular Septal Defect) | 537 | ||
| Procedural Details (Muscular Ventricular Septal Defect) | 537 | ||
| Complications | 538 | ||
| Clinical Trial Data | 538 | ||
| Post-Myocardial Infarction Ventricular Septal Defect | 538 | ||
| Management | 539 | ||
| Transcatheter Post-Myocardial Infarction Ventricular Septal Defect Closure | 539 | ||
| Conclusions | 540 | ||
| References | 541 | ||
| 33 Interventions for Advanced Heart Failure | 543 | ||
| Introduction | 543 | ||
| Defining Advanced Heart Failure | 543 | ||
| Hemodynamics of Heart Failure | 544 | ||
| Percutaneous Mechanical Circulatory Support | 545 | ||
| Intra-aortic Balloon Pump Counterpulsation | 546 | ||
| Percutaneous Rotodynamic Pumps | 548 | ||
| Circulatory Support for Cardiogenic Shock and Advanced Heart Failure | 551 | ||
| Interventional Therapy for Right Heart Failure | 551 | ||
| Emerging Percutaneous Circulatory Support Devices | 554 | ||
| Percutaneous Coronary Intervention (PCI) in the Heart Failure Patient | 554 | ||
| Valvular Interventions in Advanced Heart Failure | 556 | ||
| Transcatheter Aortic Valve Replacement in Advanced Heart Failure | 556 | ||
| Percutaneous Approaches for Functional Mitral Regurgitation | 557 | ||
| Emerging Interventional Approaches for Heart Failure | 557 | ||
| Percutaneous Ventricular Volume Reduction | 557 | ||
| Interventions for Heart Failure With Preserved Ejection Fraction | 558 | ||
| Invasive Approaches for Patients Requiring Left Ventricular Assist Device Support | 558 | ||
| Conclusions | 559 | ||
| References | 559 | ||
| 34 Endomyocardial Biopsy | 562 | ||
| Introduction | 562 | ||
| Development of the Procedure—A Historic Perspective | 562 | ||
| Technique of the Procedure | 563 | ||
| Safety of Endomyocardial Biopsy | 564 | ||
| Processing Endomyocardial Tissue Specimens | 566 | ||
| Indications for Endomyocardial Biopsy | 566 | ||
| Utility of Endomyocardial Biopsy in Cardiac Transplant Allografts | 569 | ||
| Expert Practice Summary | 570 | ||
| Conclusions | 570 | ||
| References | 570 | ||
| 35 Pericardiocentesis and Pericardial Intervention | 572 | ||
| Introduction | 572 | ||
| The Normal Pericardium | 572 | ||
| Pericardial Effusion and Tamponade | 573 | ||
| Clinical Diagnosis of Pericardial Tamponade | 573 | ||
| Indications for Pericardiocentesis | 574 | ||
| Pericardiocentesis Technique | 574 | ||
| PostPericardiocentesis Catheter Management | 575 | ||
| Complications of Pericardiocentesis | 576 | ||
| Malignant, Recurrent, or Persistently Draining Pericardial Effusions | 576 | ||
| Technique of Single Balloon Percutaneous Balloon Pericardiotomy | 577 | ||
| Technique of Double Balloon Percutaneous Balloon Pericardiotomy | 578 | ||
| Outcomes after Percutaneous Balloon Pericardiotomy | 579 | ||
| Percutaneous Pericardial Biopsy | 579 | ||
| Technique of Percutaneous Pericardial Biopsy | 580 | ||
| Role of Pericardioscopy | 580 | ||
| Percutaneous Epicardial Access for Electrophysiology Studies and Ablation | 581 | ||
| Technique of Pericardial Access and Epicardial Mapping and Ablation | 581 | ||
| Limitations and Potential Complications of Pericardial Access and Epicardial Ablation | 582 | ||
| Percutaneous Pericardial Access for Transcatheter Left Atrial Appendage Ligation | 582 | ||
| Preprocedural Considerations | 583 | ||
| Technique of Percutaneous Transpericardial Left Atrial Appendage Exclusion | 583 | ||
| Procedural Complications | 585 | ||
| Conclusions | 586 | ||
| References | 586 | ||
| VII Congenital Heart Disease | 589 | ||
| 36 Congenital Heart Disease | 589 | ||
| Introduction | 589 | ||
| Catheter-Based Interventions for Congenital Heart Disease | 589 | ||
| Coarctation of the Aorta—Native or Restenosis for Intervention | 589 | ||
| Arteriovenous Fistulae or Malformations | 591 | ||
| Coronary Artery Fistulae | 591 | ||
| Pulmonary Arteriovenous Malformations | 592 | ||
| Anomalous Venovenous Connections Causing Systemic Hypoxemia | 593 | ||
| Valvular Heart Disease Secondary to Congenital Etiology | 594 | ||
| Pulmonary Valvuloplasty | 594 | ||
| Transcatheter Pulmonary Valve Placement | 594 | ||
| Aortic Valve | 596 | ||
| Pulmonary Hypertension in Congenital Heart Disease | 597 | ||
| Overview | 597 | ||
| Eisenmenger Syndrome/Secondary Pulmonary Hypertension | 597 | ||
| Future Directions | 597 | ||
| Covered Stent Technology | 597 | ||
| Investigational Transcatheter Pulmonary Valve Technology | 598 | ||
| Conclusions | 599 | ||
| Acknowledgment | 599 | ||
| References | 599 | ||
| Index | 601 | ||
| A | 601 | ||
| B | 603 | ||
| C | 604 | ||
| D | 607 | ||
| E | 607 | ||
| F | 608 | ||
| G | 609 | ||
| H | 609 | ||
| I | 610 | ||
| J | 612 | ||
| K | 612 | ||
| L | 612 | ||
| M | 613 | ||
| N | 614 | ||
| O | 614 | ||
| P | 615 | ||
| Q | 617 | ||
| R | 617 | ||
| S | 618 | ||
| T | 620 | ||
| U | 621 | ||
| V | 621 | ||
| W | 622 | ||
| X | 622 | ||
| Y | 622 | ||
| Endsheet 7 | IBC7 |