Embolization of a Large Intracoronary Thrombus During ST-Segment Elevation Myocardial Infarction
Smilowitz, Nathaniel R; Serrano-Gomez, Claudia
Aspiration thrombectomy was performed to retrieve intact thrombus in a 69-year-old woman. Bradycardia and hypotension rapidly resolved. Balloon angioplasty was performed at the site of proximal RCA in-stent restenosis with improved angiographic appearance and TIMI 3 flow in the major branches.
Effect of Left Versus Right Radial Artery Approach for Coronary Angiography on Radiation Parameters in Patients With Predictors of Transradial Access Failure
Shah, Binita; Burdowski, Joseph; Guo, Yu; Velez de Villa, Bryan; Huynh, Andrew; Farid, Meena; Maini, Mansi; Serrano-Gomez, Claudia; Staniloae, Cezar; Feit, Frederick; Attubato, Michael J; Slater, James; Coppola, John
Left transradial approach (TRA) for coronary angiography is associated with lower radiation parameters than right TRA in an all-comers population. The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. Patients with predictors of TRA failure (>/=3 of 4 following criteria: age >/=70 years, female gender, height =64 inches, and hypertension) referred to TRA operators were randomized to either right (n = 50) or left (n = 50) TRA, whereas those referred to transfemoral approach (TFA) operators were enrolled in a prospective registry (n = 50). The primary end point was the radiation measure of dose-area product (DAP). In an intention-to-treat analysis, DAP (34.1 Gy.cm2 [24.9 to 45.6] vs 41.9 Gy.cm2 [27.3 to 58.0], p = 0.08), fluoroscopy time (3.7 minutes [2.4 to 6.3] vs 5.6 minutes [3.1 to 8.7], p = 0.07), and operator radiation exposure (516 muR [275 to 967] vs 730 muR [503 to 1,165], p = 0.06) were not significantly different between left and right TRA, but total dose (411 mGy [310 to 592] vs 537 mGy [368 to 780], p = 0.03) was significantly lower with left versus right TRA. Radiation parameters were lowest in the TFA cohort (DAP 24.5 Gy.cm2 [15.7 to 33.2], p <0.001; fluoroscopy time 2.3 minutes [1.5 to 3.7], p <0.001; operator radiation exposure 387 muR [264 to 557]; total dose 345 mGy [250 to 468], p = 0.001). Results were similar after adjustment for differences in baseline characteristics. In conclusion, median measurements of radiation were overall not significantly different between left versus right TRA in this select population of patients with predictors of TRA failure. All measurements of radiation were lowest in the TFA group.
Effect of left versus right radial artery approach to coronary angiography on radiation exposure in patients with predictors of transradial artery access failure [Meeting Abstract]
Shah, Binita; Burdowski, Joseph; Guo, Yu; de Villa, Bryan Velez; Huynh, Andrew; Farid, Meena; Maini, Mansi; Serrano-Gomez, Claudia; Fallahi, Arzhang; Staniloae, Cezar S; Attubato, Michael; Feit, Frederick; Slater, James; Coppola, John