Prevention of Complications of Coronary Arteriography

Abstract

(1) Death or the serious nonfatal complications of myocardial infarction and/or cerebral embolus occur in an unacceptable 1.5% of all patients examined; the occurrence is ten times higher in institutions performing fewer than 100 examinations/year than in those doing more than 400/year. Reported death rates vary more than one hundred fold, from 0.05% to 8%.1, 2 (2) The serious complications, primarily thrombotic, occur eight times more frequently when the percutaneous transfemoral approach is used. (3) Fifty-five percent of laboratories using a femoral method do fewer than 50 cases/year. As volume increases, the complication disparity between the brachial and the femoral approach dramatically narrows to near equality.The reported complication rates are unacceptably high. Two clearly evident factors emerge: (1) the competence of the operator (training and main-

Intracoronary ultrasound examinations reveal significantly more advanced coronary atherosclerosis in people with type 1 diabetes than in age- and sex-matched non-diabetic controls

“…10 The IVUS system was the Clear View Ultra with Automatic Pullback Device and Ultra Cross 3.2 F -30 MHz catheters (Boston Scientific, USA). A standard dose of intracoronary nitrate (100-200 mcg) was administered before acquisition of images.…”

Relationship of anticoagulation and radiographic contrast agents to thrombosis during coronary angiography and angioplasty: Are there real concerns?

“…Another smaller report from approximately the same time in patients undergoing femoral coronary arteriography from Walker et al [5], showed a 17.8% incidence of thromboembolic complications in patients not given systemic heparin compared to 1.3% in those who received anticoagulation. Shortly after the release of these reports, Judkins and Ganden [6] editorialized that systemic anticoagulation with heparin should be routinely used during coronary arteriography to counteract the inherent thrombogenicity of the guidewires and catheters utilized, particularly with the femoral technique.…”

Effect of prolonged blood contact time on deposition of cellular and amorphous material on Teflon-coated guidewires: A scanning electron microscopy study

“…The incidence of major thromboembolic complications in early reports varied widely from 0.05% to 8% [2,11]. In a 1974 editorial, Judkins and Gander implicated a variety of possible factors: i.e., the catheterization route (brachial versus femoral), the coagulation status of the patient (use of systemic heparinization), operator experience and duration of the procedure [2]. The Society for Cardiac Angiography and Interventions presented data on 222,553 patients collected in their registry between July 1984 and December 1987 [ 121.…”