Distal radial access for coronary angiography and percutaneous coronary intervention: A state-of-the-art review.

Since its introduction by Lucien Campeau three decades ago, percutaneous radial artery approach at the forearm has been shown to provide advantages over the femoral approach and has become the standard approach for coronary angiography and intervention. Though infrequent, vascular complications still remain, mainly radial artery occlusion. Therefore, a more distal radial approach at the snuffbox or at the dorsum of hand has been suggested, initially by anethesiologists for perioperative patient monitoring, and more recently by Babunashvili et al. for retrograde radial artery recanalization of radial artery occlusion and then for coronary angiography and intervention. This distal radial approach has been advocated to reduce the risk of radial artery occlusion at the forearm (which precludes reintervention through the same access site) and bleeding and vascular access site complications, as well as to improve operator and patient comfort, especially when using left radial approach. This review describes in detail the anatomy of the radial artery at the wrist and the hand, the history of distal radial access, the rationale underlying use of this technique, the results published by experienced operators, the technique, the limitations, and potential role of this approach. This journey from the very proximal to the very distal part of the radial artery was indeed initiated and conceptualized by Lucien Campeau himself.

Early diagnosis of atherosclerosis with panoramic radiographs: a review / O diagnóstico precoce de aterosclerose através de radiografias panorâmicas: uma revisão

Abstract Carotid artery disease has been linked with cerebral vascular accident, also known as stroke, cerebral hemorrhage, or cerebral ischemia. It is caused by narrowing or obstruction of arteries in the neck (the carotid arteries) that are responsible for transporting blood from the aorta to the brain. Panoramic radiographs are used in dentistry to show both dental arches as a supplement to the clinical dental examination. The objective of this study is to highlight the importance of panoramic radiographs for diagnosis of arterial disease, by means of a bibliographic review. The PubMed database was searched using the keywords “atherosclerosis” and “panoramic”, with the filters “last 5 years” and “humans”. Twenty articles were identified, six of which were chosen for this study because they were open access. The review concluded that panoramic radiographs enable early diagnosis of carotid artery calcification, resulting in earlier interventions, and offer an accessible cost.

Resumo Doenças das artérias carótidas estão associadas a casos de acidente vascular cerebral, também chamados de derrame ou isquemia cerebral. Ocorrem devido ao estreitamento ou obstrução das artérias do pescoço, ou artérias carótidas, responsáveis por levar o sangue da aorta para o cérebro. A radiografia panorâmica é um exame de ambos os arcos dentários que ajuda no exame clínico odontológico. Destacar a importância da radiografia panorâmica no diagnóstico de doença arterial é o objetivo deste trabalho, que foi realizado através de pesquisa bibliográfica na PubMed, com as palavras-chave “atherosclerosis” e “panoramic”, e os filtros: últimos 5 anos e humanos. Vinte artigos foram elencados, dos quais seis formaram a base para este estudo, graças ao acesso livre ao seu conteúdo. Conclui-se que a radiografia panorâmica permite o diagnóstico precoce de calcificação da artéria carótida, levando a uma intervenção precoce a um custo acessível.

The History of Primary Angioplasty and Stenting for Acute Myocardial Infarction.

The evolution of the management of acute myocardial infarction (MI) has been one of the crowning achievements of modern medicine. At the turn of the twentieth century, MI was an often-fatal condition. Prolonged bed rest served as the principal treatment modality. Over the past century, insights into the pathophysiology of MI revolutionized approaches to management, with the sequential use of surgical coronary artery revascularization, thrombolytic therapy, and percutaneous coronary intervention (PCI) with primary coronary angioplasty, and placement of intracoronary stents. The benefits of prompt revascularization inspired systems of care to provide rapid access to PCI. This review provides a historical context for our current approach to primary PCI for acute MI.

Coronary artery calcium scanning: past, present, and future.

Coronary artery calcium scanning (CAC) has emerged as the most robust predictor of coronary events in the asymptomatic primary prevention population, particularly in the intermediate-risk cohort. Every study has demonstrated its superiority to risk factor-based paradigms, e.g., the Framingham Risk Score, with outcome-based net reclassification indexes ranging from 52.0% to 65.6% in the intermediate-risk, 34.0% to 35.8% in the high-risk, and 11.6% to 15.0% in the low-risk cohorts. CAC improves medication and lifestyle adherence and is cost-effective in specified populations, with the ability to effectively stratify the number needed to treat and scan for different therapeutic strategies and patient cohorts. Data have emerged clearly demonstrating the worse prognosis associated with increasing CAC on serial scans, suggesting a potential role for evaluating residual risk and treatment success or failure. CAC is also strongly associated with the development of stroke and congestive heart failure.

The ten advances that have defined modern cardiology.

Modern cardiology was born early in the twentieth century. Here I list and review what I believe to be the ten most important advances in the twentieth century in this field. They are as follows: electrocardiography, cholesterol-induced atherosclerosis, cardiac catheterization, cardiovascular surgery, coronary angiography and percutaneous coronary angioplasty, the coronary care unit, the development of new cardiovascular drugs, preventive cardiology, cardiac imaging, and implanted cardiac pacemakers/defibrillators.

Vascular access and closure in coronary angiography and percutaneous intervention.

The key feature defining transcatheter cardiovascular interventions is that access to the vessels and heart is achieved by arterial puncture with a needle, rather than surgical incision with a scalpel. However, arteriotomy and vessel closure are performed without direct visualization of the arterial wall, which risks vessel damage and bleeding. Vascular closure devices offer the potential for enhanced control of access-site haemostasis and reduced complications in comparison with manual compression. However, although randomized clinical trials have shown reductions in time to haemostasis and ambulation, the data do not demonstrate consistent reductions in access-site complications or improvements in clinical outcomes. Another approach to increase the safety of percutaneous procedures is to use radial, rather than femoral, arterial access, a strategy that has polarized opinions among cardiologists. Clinical trial data show a clear reduction in access-site bleeding and complications with radial access, at the expense of a marginal increase in markers of procedural efficiency. However, randomized trials have not demonstrated improved clinical outcomes with radial access. The lack of impact on prognostically relevant bleeding events could explain this null finding, although the setting of primary percutaneous coronary intervention could be an exception. Ongoing, iterative improvement in catheter technologies, as well as in adjuvant antiplatelet and antithrombotic therapies, are likely to underlie the difficulty in demonstrating clear outcome benefits with different vascular access and closure strategies.

Discovery of cerebrovascular moyamoya disease: research during the late 1950s and early 1960s.

Carotid angiography employing a percutaneous technique, which was devised by Shimizu in 1937, was popularized among neurosurgeons in Japan soon after World War II. This opened up an opportunity for them to encounter and investigate moyamoya disease, since this disease is more common among Asians. They began to publish their findings on what is currently called moyamoya disease in the Japanese literature during the late 1950s and early 1960s. It was only in the late 1960s, however, that their studies were published in the English literature. The early history of the discovery of this disease is therefore not widely known. In 1957, Takeuchi and Shimizu reported a case of an unknown disease characterized by hypoplasia of the internal carotid arteries. In 1964, Moriyasu and his colleagues published a report of four child cases with occlusion of the internal carotid artery. They also published in the same year a report of five adult cases with occlusion of the internal carotid arteries for an unknown reason, placing special emphasis on an abnormal vascular network located at the base of the brain, which is presently termed moyamoya vessels. In 1968 and 1969, Kudo, Nishimoto, and Takeuchi, as well as Suzuki and Takaku, published their studies in the English literature, which contributed greatly to the recognition of moyamoya disease throughout the world. Takeuchi and Shimizu, and Moriyasu also deserve credit as the researchers who reported the crucial features of moyamoya disease for the first time.

A half century of selective coronary arteriography.

The first "selective" coronary arteriogram was made 50 years ago by Dr. F. Mason Sones at the Cleveland Clinic. Soon afterward coronary arteriography was developed as a diagnostic method suitable for widespread clinical application. This method has revolutionized our understanding of coronary artery disease and has become the basis for selecting and evaluating therapeutic interventions. This Viewpoint commemorates the achievements of the pioneers of coronary arteriography, the difficulties they encountered, and their impact on the development of modern cardiology. Developments during the last half century and prospects for the future are discussed in historical perspective.

History of cardiac computed tomography: single to 320-detector row multislice computed tomography.

Since the introduction of computed tomography (CT) over 30 years ago, the challenge of imaging the beating heart has been a driving force in the innovation of cardiac CT. Imaging the anatomy and physiology of the heart demands temporal, spatial and contrast resolution is arguably greater than for any other organ system in the body. Great progress has been achieved in using CT to evaluate coronary artery stenosis and plaque composition. In addition, techniques to evaluate cardiac function, including myocardial perfusion, regional ventricular wall motion, systolic thickening, ejection fraction, valve function, and congenital cardiac abnormalities are also gaining a foothold in clinical practice as adjuncts to or replacements for invasive coronary angiography, cardiac single photon emission CT (SPECT) imaging, ultrasound and magnetic resonance imaging (MRI). This review summarizes the major accomplishments and future directions in this field, with emphasis on developments over the past 10 years.

Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15 years.

Since its introduction, the TIMI frame count method has contributed to the understanding of the pathophysiology of coronary artery disease. In this article, the evolution of the TFC method and its applicability in the assessment of various therapeutic modalities are described.