Kintur Sanghvi

Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention's transradial working group.

Duke University Medical Center, Durham, North Carolina Stanford University Medical Center, Palo Alto, California Penn State Hershey Medical Center, Hershey, Pennsylvania Brigham and Women’s Hospital, Boston, Massachusetts Mayo Clinic, Rochester, Minnesota University of Illinois at Chicago/Jesse Brown VA Medical Center, Chicago, Illinois First Coast Heart and Vascular Center, Jacksonville, Florida G.V. (Sonny) Montgomery VA Medical CenterJackson, Mississippi. Stern Cardiovascular Foundation, Memphis, Tennessee Reid Heart Center at FirstHealth of the Carolinas, Pinehurst, North Carolina Deborah Heart & Lung Institute, Browns Mills, New Jersey Duke University Medical Center, Durham, North Carolina Lahey Clinic, Burlington, Massachusetts Geisinger Medical Center, Danville, Pennsylvania Apex Heart Institute, Seth N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, Pennsylvania

Histopathologic changes of the radial artery wall secondary to transradial catheterization

Objective: The immediate effects of transradial access on the radial artery wall are unknown. In this study we sought to assess the histological changes induced by catheterization on the radial artery. Methods: Thirty-four patients undergoing coronary artery bypass grafting (CABG) had radial arteries harvested to serve as bypass conduits. The proximal and distal ends of the radial artery conduits were sectioned and embedded in paraffin. Both ends of all specimens were evaluated by a blinded pathologist for intimal hyperplasia, medial inflammation, medial calcification, periarterial tissue or fat necrosis, adventitial inflammation, adventitial necrosis, and adventitial neovascularization. Fisher’s exact test was used for statistical analysis. Results: Fifteen previously catheterized radial arteries (TRA group) were compared with 19 noncatheterized arteries (NCA group). The distal ends of the TRA group showed significantly more intimal hyperplasia (73.3% vs 21.1%; p = 0.03), periarterial tissue or fat necrosis (26% vs 0%; p = 0.02), and more adventitial inflammation (33.3% vs 0%; p = 0.01) than the distal ends of the NCA group. The distal ends of the TRA group also showed significantly more intimal hyperplasia (73.3% vs 26.6%; p = 0.03) and adventitial inflammation (33.3% vs 0%; p = 0.01) than the proximal ends of the same arteries. There were no histological differences in the proximal ends of the two groups. Conclusion: Transradial catheterization induces significant histological changes suggestive of radial artery injury limited to the puncture site in the form of intimal hyperplasia, medial inflammation, and tissue necrosis. Both the proximal and distal ends of the radial artery show a spectrum of atherosclerotic changes independent of its use for transradial catheterization.

Radial artery access technique evaluation trial: Randomized comparison of seldinger versus modified seldinger technique for arterial access for transradial catheterization

Background: Radial artery access for transradial catheterization is obtained using either Seldinger or modified Seldinger technique. There is no comparative evaluation of the safety and benefits of these two techniques. Methods: Four hundred twelve patients undergoing transradial catheterization were randomized to group I (n = 210) Seldinger technique, and group II (n = 202) modified Seldinger technique. Demographic and procedural data were collected at the time of the procedure. Data on hematoma and radial artery occlusion (RAO) were recorded at 24 hr and 30 days after the procedure. Results: Age, gender, weight, height, and history of diabetes mellitus were comparable between groups I and II. Access time (78.3 ± 37.7 sec vs. 134.2 ± 87.5 sec, P < 0.001), procedure time (17.1 ± 6.4 min vs. 19.3 ± 7.1 min, P < 0.01), number of attempts to get access (1.7 ± 0.8 vs. 2.2 ± 0.8, P < 0.001), were significantly different favoring group I. Access was obtained at first attempt in 53% of patients in group I compared with 16% in group II (P < 0.001). Change in technique (crossover) was required in 10.8% of group II patients, compared with no crossover in group I (P < 0.0001). Incidence of hematoma (0.5% vs. 1.5%, P > 0.2) and 30‐day RAO (4.3% vs. 3.9 %, P > 0.5) was similar between groups I and II. Conclusions: Seldinger technique is a faster and more predictable radial artery access technique compared with modified Seldinger technique with no increase in bleeding or RAO.

Broken guidewire fragment: A simplified retrieval technique

We report a technique for retrieval of a broken angioplasty wire fragment from the coronary system using a more simplified technique that does not involve the use of a snare or any other retrieval tool. With the use of an additional angioplasty wire and a balloon catheter, we could safely remove the broken wire fragment from the coronary system and circulation in a very short time. Cathet. Cardiovasc. Intervent. 51:483–486, 2000.

Transradial intervention of iliac and superficial femoral artery disease is feasible.

BACKGROUND Percutaneous intervention of iliac artery (IA) and superficial femoral artery (SFA) disease is often performed via ipsilateral or contralateral femoral access. However, this approach may be difficult in patients with severe iliac or common femoral artery atherosclerosis, morbid obesity, or conditions prohibiting prolonged bed rest. Percutaneous transradial coronary intervention has gained popularity due to the low frequency of access site complications, early ambulation, and perhaps cost savings with early discharge. Transradial intervention (TRI) of IA and SFA disease has been previously described only in anecdotal case reports. METHODS Out of 159 patients who underwent IA and SFA intervention, 15 had their intervention attempted via the radial artery. TRI was attempted at the operators discretion for one of the following reasons: absent femoral pulses, severe bilateral IA disease, obesity, or conditions prohibiting prolonged supine rest. Clinical and procedural characteristics were collected retrospectively. RESULTS Fourteen patients (93%) had successful intervention completed through the transradial approach. One patient needing an intervention of the distal SFA was converted to contralateral femoral approach because of the inadequate stent shaft length. Eighteen IA lesions and six SFA lesions were treated successfully with a good final angiographic result via a 6 FR radial access system. The ankle brachial index improved from a mean of 0.66 to 0.93. None of the patients had any procedural or access site-related complications. CONCLUSIONS TRI is a feasible and safe alternative for percutaneous treatment of IA and SFA disease in carefully selected patients.

A unique complication of the GuideZilla guide extension support catheter and the risk of stent stripping in interventional & endovascular interventions.

Supporting catheters in percutaneous stenting of anatomically difficult coronary lesions are utilized by interventional cardiologists. The GuideZilla guide extension catheter is designed for deep seating in coronary arteries to provide extra guidance support for equipment delivery during difficult coronary interventions or for coaxial alignment in tortuous vessels. There are limited GuideZilla-related complications reported in the literature. We present a challenging case of a left main and left anterior descending artery dissection, complicated with stent stripping off the delivery balloon by the GuideZilla support catheter.

Ostial left main occlusion following surgical aortic valve replacement (SAVR)

Left main coronary artery (LMCA) obstruction may occur following both transcatheter and surgical aortic valve replacement (SAVR).We present images of LMCA obstruction follow SAVR and describe its management with a bare metal stent (BMS). A 70-year-old femalewith a bicuspid aortic valve and severe aortic stenosis (mean gradient of 51mmHg; aortic valve area of 0.78 cm) and a 70% first diagonal stenosis underwent a SAVR with a 19-mm Medtronic Mosaic bioprosthesis (Medtronic Inc., Minneapolis, MN)

Percutaneous Closure of a Perimembranous Ventricular Septal Defect Through Arm Approach (Radial Artery and Basilic Vein)

We report a case of percutaneous closure of a congenital perimembranous ventricular septal defect (VSD) performed via a radial artery and basilic vein accesses. We further discuss the technique, advantages, and limitation of this innovative approach for perimembranous VSD closure.

Prophylactic Ipsilateral Superficial Femoral Artery Access in Patients With Elevated Risk for Femoral Access Complications During Transfemoral Transcatheter Aortic Valve Replacement

We report 2 patients, both men, 87 and 82 years of age, with severe aortic stenosis scheduled for transcatheter aortic valve replacement (TAVR), both with histories of lower extremity peripheral artery disease and endovascular abdominal aortic aneurysm repair with presence of dense bilateral groin

Intervention of Prohibitive Aortic and Iliac Atherosclerotic Stenosis to Allow Successful Transfemoral Transcatheter Aortic Valve Replacement

We present a case of a 91-year-old woman who presented with symptomatic severe aortic stenosis with an aortic valve area of 0.4 cm2 and mean gradient of 41 mm on echocardiography. She had undergone a thorough evaluation at an outside facility. She was deemed high risk with an STS risk score of >11%