Book Excerpts

Chapter 21: Management of Patients on Chronic Oral Anticoagulant Therapy
R. Lee Jobe, MD, FACC, FSCAI

Patients with coronary artery disease frequently have comorbid conditions requiring chronic oral anticoagulant (OAC) therapy, such as atrial fibrillation, valvular heart disease, arterial or venous thromboembolic disease, or left ventricular thrombus.

Chapter 22: Right Heart Catheterization Using Forearm Vein Access
Ian C. Gilchrist, Sr., MD, FACC, FSCAI

Radial catheterization should not be considered a niche technique isolated to the arterial tree. The forearm is also the source of a rich supply of veins that can offer conduits for right heart catheterization.

Chapter 23: Same-Day Discharge After Successful PCI
Eltigani Abdelaal, MD, MRCP and Olivier Bertrand, MD, PhD

Percutaneous Coronary Intervention (PCI) is the most commonly performed cardiac intervention in contemporary practice, with over 50% of all procedures performed in the United States.

Chapter 24: Economics
Max Weiss, MD; Daniel Feldman, MD; Adhir Shroff, MD, MPH

A growing body of literature suggests that the transradial approach (TRA) for diagnostic angiography and percutaneous coronary intervention (PCI) is associated with a significantly lower cost when compared to the transfemoral approach (TFA). Recent studies suggest that total intra- and post-procedural costs of TRA diagnostic angiography and PCI are $275-$830 less when compared to TFA.

Chapter 25: Repeated Access: Transradial Angiography and Intervention
Pinak B. Shah, MD

One of the major limitations to radial access is the concern for radial artery occlusion (RAO). RAO occurs in 1% to 10% of cases depending on how it is assessed. Several prior chapters have been devoted to RAO and options to prevent it. Most cases of RAO are silent and do not cause the patient harm or discomfort.

Chapter 26: Radial Artery Spasm
Kintur Sanghvi, MD, FACC, FSCAI

Radial artery (RA) access provides multiple advantages over other access options for catheterization procedures as described earlier in this book. These advantages are offset by a relatively frequent occurrence of radial artery spasm (RAS), which can turn this elegant, patient-friendly procedure into a painful, tedious, and rarely impossible procedure.

Chapter 27: Left Internal Mammary Artery Angiography via the Transradial Approach with the Bartorelli-Cozzi Catheter
Antonio L. Bartorelli, MD, FACC, FESC; Cristina Ferrari, MD; Sergio Cozzi, MD

History of the Bartorelli-Cozzi catheter

Chapter 28: Universal Guiding Catheters
Yuji Ikari, MD, PhD, FACC, FESC

There are several universal guiding catheters that can be engaged both for left and right coronary arteries. What is the benefit of a universal guiding catheter? First, it can reduce cost in case of PCI for both left and right coronary arteries. Second, it can reduce time by avoiding catheter exchange.

Chapter 29: Switching: Contralateral or Femoral?
Vikas Singh, MD and Mauricio G. Cohen, MD, FACC, FSCAI

Transradial (TR) access for percutaneous coronary procedures reduces vascular complications and bleeding, and thus improves clinical outcomes compared to the transfemoral (TF) approach. Yet, radial access is underutilized in clinical practice in many countries including the United States.

Chapter 30: Transradial Procedures and Left Ventricular Hemodynamic Support
Christopher T. Pyne, MD

The transradial approach for management of hemodynamically unstable patients has been termed the “final frontier” of the radial approach. Even experienced radial operators continue to use the femoral approach in ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock. In general, physicians site two reasons for preferring the femoral approach in STEMI patients with shock.