Percutaneous Coronary Intervention

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Improve angina in patients with one or more significant (≥70% diameter) coronary artery stenoses despite optimal medical therapy.
  • Improve cardiovascular outcomes in patient presenting with acute coronary syndromes due to vessel occlusion.
  • For left main and/or complex CAD, PCI to improve survival may be indicated in the setting when patients are not candidates for CABG or if there is significant increased risk of adverse surgical outcomes.
CONTRAINDICATIONS
  • There are no absolute contraindications.
  • Relative contraindications include the following:
    • Coagulopathy
    • Decompensated congestive heart failure
    • Uncontrolled hypertension
    • Active stroke
    • Refractory arrhythmia
    • Active gastrointestinal tract bleeding
    • Pregnancy
    • Inability of patient to cooperate
    • Active infection
    • Renal failure
    • Contrast allergy in the absence of premedication
EQUIPMENT
  • Sterile mask, cap, gown, gloves
  • Sterile sheet over patient
  • Crash cart with resuscitation equipment and defibrillator
  • Manifold setup and/or power contrast injector
  • One percent lidocaine
  • Twenty-one–gauge needle and syringe for local anesthesia
  • Eighteen-gauge Seldinger/Cook needle
  • Vascular introducer sheath (various French sizes) with J-tipped wire
  • One hundred eighty–inch or longer 0.035-inch J-tipped guidewire
  • Low osmolar contrast agent (ionic or nonionic media)
  • Guide catheters (e.g., EBU, JR, VL)
  • Guidewires (BMW, Prowater, Pilot)
  • CoPilot accessory kit
  • Inflation device kit (2-foot extension tubing, insufflator, 3-way stopcock)
  • Balloon dilatation catheters (on-the-wire, over-the-wire, and monorail types)
  • Stents (DES and BMS)
  • Postdilation balloon catheters
  • Adjunctive devices: atherectomy (rotational atherectomy, directional coronary atherectomy, mechanical thrombectomy, and embolic protection)
ANATOMY
  • Right or left femoral artery
    • Alternative vascular access sites (e.g., radial, brachial) can be used.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Continue bed rest and postcatheterization care per institutional protocol.
  • If IV heparin was administered during the case, remove the sheath when the ACT is less than 140 to 160 seconds.
  • If IV bivalirudin was administered, remove the sheath after 2 hours after the procedure if glomerular filtration rate is greater than 60 mL/min. Please follow institutional protocol on sheath removal in the presence of renal dysfunction.
COMPLICATIONS
  • Bleeding
  • Vascular injury (e.g., femoral artery dissection)
  • Iatrogenic coronary artery dissection
  • Coronary perforation
  • Air embolism
  • Stroke
  • Arrhythmia
  • Cardiac arrest
  • Myocardial infarction
  • Death
  • Tamponade
RESULT ANALYSIS

Angiographic success after PCI with stenting is gauged by <20% residual stenosis, absence of edge dissection or perforation, and TIMI 3 flow into the distal target vessel.

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