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Coronary Artery Disease: Diagnosis and Treatment

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Presentation on theme: "Coronary Artery Disease: Diagnosis and Treatment"— Presentation transcript:

1 Coronary Artery Disease: Diagnosis and Treatment
Northwestern Memorial Hospital Healthy Transitions Fall Program October 7, 2013 Coronary Artery Disease: Diagnosis and Treatment Mark J. Ricciardi, MD Director, Interventional Cardiology and Cardiac Catheterization Northwestern Bluhm Cardiovascular Institute

2 Outline Coronary artery disease (CAD) basics Diagnosis of CAD
Cardiac Catheterization / Coronary Angiography Treatment of CAD Coronary Angioplasty / Stent Past, present, future

3 Coronary Disease Atherosclerosis ‘Arteriosclerosis’
Fatty buildup in lining of artery wall Plaque Impinges on flow Reduces amount of blood and oxygen delivered to the heart muscle

4 Cholesterol deposition

5 Early CAD

6 Vulnerable Plaque Plaque Rupture

7 Coronary Thrombosis “Heart Attack”

8 CAD the goal… is prevention Primary prevention
Prevent early / sub-clinical stages Heart healthy lifestyle Starting in childhood Medications Targeted at high risk groups

9 Diagnosis of CAD History Symptoms Angina

10 Diagnosis of CAD History Non-invasive imaging Symptoms Angina
Stress testing provocation CT angiogram good, not great

11 Diagnosis of CAD Invasive imaging History Non-invasive imaging
Symptoms Angina Non-invasive imaging Stress testing CT angiogram Invasive imaging Left heart catheterization / coronary angiography … the gold standard for Dx

12 Coronary Angiography Purposes
Define coronary anatomy, and presence, absence, degree obstruction Most commonly used to: determine extent of CAD assess feasibility and appropriateness of mechanical revascularization

13 Catheterization

14 Catheterization

15 Coronary Angiography

16 Coronary Angiography

17 Arterial access Femoral artery
Most common access site since 1980s Easy and reliable Often requires minutes of pressure to prevent bleeding - followed by bed-rest 1% risk significant bleeding There are new strategies that hasten recovery time Bleeding still an issue

18 Arterial access Radial artery
Lower risk of significant bleeding No bed rest required

19 Arterial access Radial artery

20 Arterial access Radial artery
“Down side” -the learning curve

21 CAD Treatment

22 CAD Treatment The past…

23 CAD Treatment Secondary prevention Lifestyle modification
Diet, exercise, tobacco cessation Rx underlying risk factors Aspirin and ‘statin’ medications Anti-anginal medications Beta blockers

24 Coronary Bypass

25 Coronary Angioplasty

26 Coronary Angioplasty

27 Coronary Stenting

28 Coronary Stenting

29 Drug Stents

30 Northwestern Memorial Hospital Cardiac Catheterization Center
Chicagoland’s First: Coronary Stent (1990s) Drug eluting stent (early 2000s)

31 Northwestern Memorial Hospital Cardiac Catheterization Center
Chicagoland’s First: Coronary Stent (1990s) Drug eluting stent (early 2000s) Bio-absorbable stent (2013)

32 Next Generation Stents
Bioabsorbable / dissolving stents In clinical trials at Northwestern

33 Conclusions CAD Symptomatic CAD CAD Treatment
Sub-clinical plaque formation Symptomatic CAD Angina, heart attack Non-invasive and invasive testing CAD Treatment Behavioral, pharmacologic, mechanical NW big part of the past, present and future of CAD Rx

34 Questions?


36 Judkins Technique JL and JR catheters Melvin Judkins
Radiology associate of Charles Dotter at University of Oregon, had studied coronary angiography with Dr. Mason Sones. Went on to create own system of diagnostic imaging, introducing a series of specialized catheters and perfecting transfemoral approach (introducing the catheter via a groin puncture rather than the more complex procedure used by Sones of introducing the catheter via surgical opening of the brachial artery in the arm).

37 Cineangiography Angiographic views

38 Femoral Artery Hemostasis Perclose Suture-Mediated Closure System (Abbott Vascular)
Non-braided polyester suture Automated knot tying Closure of 5-8Fr. access sites ‘pre-closure’

39 Transradial Angiography / Intervention Anatomy
No associated major nerve Median N in carpal tunnel Ulnar N runs with UA Dual arterial supply to hand RA and UA join in 2 arches Superficial and deep palmar arches #1 you can get to the heart from here. #2 dual supply to hand

40 Radial Artery Compression Devices


42 The most important bleeding avoidance strategy?
Femoral Radial

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