Tag Archives: angiography

Introduction Invasive coronary angiography is the definitive diagnostic test for assessing coronary artery patency.1 For many years, the femoral artery was the usual vascular access site for such procedures, but use of the radial artery has increased due to it being more superficial and easier to compress following the procedure. In the UK, the radial artery was used in about 10% of all coronary angiograms in 2004, and this steadily increased to 84% by 2016.2 Advantages of the radial approach include better haemostasis,3,4 earlier ambulation and increased patient satisfaction.5,6 Randomised trials comparing radial access coronary angiography

Introduction While many in the interventional cardiology community consider the debate of routine radial versus femoral access for coronary angiography to be all but over,1-5 there, nonetheless, continues to be a wide variation in the uptake of transradial access worldwide.6,7 Even putting the preferences of transradial enthusiasts aside, it also seems that patients who have had experience of both access routes prefer use of the radial artery.8 Nonetheless, femoral access undoubtedly continues to remain relevant in situations such as large bore and complex intervention, the need for mechanical support devices, and structural intervention. One

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Gentle application of counter-rotational torque may permit guidewire passage to release the knot, but usually distal catheter fixation is required. Previous reports describe ‘grabbing forceps’ or snare delivery from the contra-lateral femoral approach.1,2 We present three transfemoral CA cases, complicated by catheter knotting resolved using transradial snare delivery for distal fixation (figure 1). Figure 1. Angiographic images demonstrating a series of irreducible knotted catheters (panels Ai, Bi, Ci; white arrows), with distal catheter capture using a gooseneck snare (panels Aii, Bii, Cii) allowing catheter fixation, knot reduction (pa

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Development of cardiac computed tomography The concept of ‘computerised transverse axial scanning’ was first demonstrated by Godfrey Hounsfield nearly 30 years ago.1 Initial computed tomography (CT) scanners required up to 300 seconds for the acquisition of a single image. With such poor temporal resolution they were only suitable for imaging static structures such as the brain.2 The coronary arteries move throughout the cardiac cycle, although their velocity decreases in diastole.3 This underlies the concept of ‘gating’ the scan with the electrocardiogram (ECG), so that data are acquired preferentially during diastole.4 The advent o

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Introduction The National Health Service (NHS) Improvement Plan stated that by 2008 no one would wait longer than 18 weeks from GP referral to hospital treatment.1 This is, therefore, currently a key area of focus for the Department of Health and a major challenge for hospital trusts that provide cardiac services. ‘Chest pain’ is the most common indication for out-patient referral to cardiology. The delay between referral and out-patient review has been successfully reduced in our institution and across the UK by the rapid-access chest pain clinics (RACPC), with 96% of referrals nationwide being seen within two weeks.2 In this centre, up

Introduction Several imaging modalities are available for the optimal management of patients with cardiovascular disease. When assessing any imaging technique, the radiation dose must be considered along with the value of the imaging technique. Coronary artery evaluation using multi-slice computed tomography (MSCT) was introduced recently, and this imaging modality is expected by some to become a major new player in the field of cardiac imaging. We hereby summarise the radiation doses associated with MSCT and other currently available cardiovascular imaging techniques. Ionising radiation in medicine The benefit to patients from the medical us

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