Info
🌱 來自: Huppert’s Notes
Left Heart CatheterizationCoronary Angiogram🚧 施工中
Left Heart Catheterization/Coronary Angiogram
• Procedure: A thin catheter is placed in an artery (usually radial, sometimes femoral), advanced to the ascending aorta, and then contrast is injected to visualize the coronary arteries from their origin off of the aorta (diagnostic). Can cross the aortic valve, but this is not always performed. In addition to getting diagnostic information, it is also possible to intervene upon blockages (i.e., percutaneous coronary intervention [PCI]).
• Indications:
- CAD: Both diagnostic (can identify culprit lesion and directly measure FFR) and therapeutic (can place stent to open a blockage). Diagnose CAD in patients with symptoms, ACS, HF, VT, post-arrest.
- Aortic stenosis: Determine the severity of AS (cross the aortic valve and measure the pressure gradient)
• Percutaneous coronary interventions (PCI):
- Bare metal stents (BMS): Rarely done in current day. Largely replaced by drug-eluting stents (DES).
- Drug eluting stents (DES): Standard of care. Lower rates of restenosis compared to BMS; current generation (“3rd”) has better safety profile than first generation. Requires lifelong aspirin. Also need dual antiplatelet therapy (DAPT) × 6 months (or for 1 yr if DES is placed in the setting of ACS).
• Post-catheterization complications:
- Immediately post-catheterization:
• Stroke (risk ~0.05% at 30 days)
• Vascular access complication (~4% risk femoral; <2% risk radial): Hematoma, retroperitoneal bleeding (get STAT CT abd/pelvis, transfuse empirically), vessel damage requiring intervention (e.g., pseudoaneurysm, dissection)
• Renal injury: Risk of contrast-associated AKI in patients with CKD and high-volume contrast (>350 mL); newer low-osmolality contrast agents have reduced risk; Cr typically peaks within 3–5 days
• Coronary artery dissection, procedure-related myocardial infarction
• In-stent thrombosis: Typically presents as a STEMI that occurs minutes to months after PCI. Can occur due to a mechanical problem with the stent or discontinuation of antiplatelet therapy
- Longer-term post-catheterization:
• In-stent restenosis: Typically presents as gradual onset anginal symptoms that occur months to years after PCI