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Capodanno D, Bhatt DL, Gibson CM, James S, Kimura T, Mehran R, Rao SV, Steg PG, Urban P, Valgimigli M, Windecker S, Angiolillo DJ. Bleeding avoidance strategies in percutaneous coronary intervention. Nat Rev Cardiol 2022; 19:117-132. [PMID: 34426673 DOI: 10.1038/s41569-021-00598-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
For many years, bleeding has been perceived as an unavoidable consequence of strategies aimed at reducing thrombotic complications in patients undergoing percutaneous coronary intervention (PCI). However, the paradigm has now shifted towards bleeding being recognized as a prognostically unfavourable event to the same extent as having a new or recurrent ischaemic or thrombotic complication. As such, in parallel with progress in device and drug development for PCI, there is clinical interest in developing strategies that maximize not only the efficacy but also the safety (for example, by minimizing bleeding) of any antithrombotic treatment or procedural aspect before, during or after PCI. In this Review, we discuss contemporary data and aspects of bleeding avoidance strategies in PCI, including risk stratification, timing of revascularization, pretreatment with antiplatelet agents, selection of vascular access, choice of coronary stents and antithrombotic treatment regimens.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Marco Valgimigli
- Cardiocentro Ticino Institute and Università della Svizzera italiana (USI), Lugano, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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McHugh S, Noory A, Mishra S, Vanchiere C, Lakhter V. Vascular Access for Large Bore Access. Interv Cardiol Clin 2021; 10:157-167. [PMID: 33745666 DOI: 10.1016/j.iccl.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
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Affiliation(s)
- Stephen McHugh
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Ali Noory
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Suraj Mishra
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Catherine Vanchiere
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street (9PP), Philadelphia, PA 19140, USA.
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Kohlman-Trigoboff D, Rich K, Foley A, Fitzgerald K, Arizmendi D, Robinson C, Brown R, Treat-Jacobson D. Society for Vascular Nursing endovascular repair of abdominal aortic aneurysm updated nursing clinical practice guideline. JOURNAL OF VASCULAR NURSING 2020; 38:36-65. [PMID: 32534654 PMCID: PMC7707638 DOI: 10.1016/j.jvn.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Debra Kohlman-Trigoboff
- Duke University Medical Center, Division of Cardiology, Duke Heart and Vascular, Durham, North Carolina.
| | - Kathleen Rich
- Critical Care Administration, Franciscan Health-Michigan City, Michigan City, Indiana
| | - Anne Foley
- Department of Vascular Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Fitzgerald
- The Vascular Group, PLLC, Albany Medical Center Hospital, Albany, New York
| | - Dianne Arizmendi
- Corporal Michael Crescenz VA Hospital, Philadelphia, Pennsylvania
| | | | - Rebecca Brown
- National Institutes of Health's National Center for Advancing Translational Sciences, University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Diane Treat-Jacobson
- Nursing Research for Improved Care, University of Minnesota School of Nursing, Minneapolis, Minnesota
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4
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O'Cearbhaill ED, Laulicht B, Mitchell N, Yu L, Valic M, Masiakos P, Karp JM. A Radial Clutch Needle for Facile and Safe Tissue Compartment Access. MEDICAL DEVICES & SENSORS 2019; 2:e10049. [PMID: 33043277 PMCID: PMC7546408 DOI: 10.1002/mds3.10049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/06/2016] [Indexed: 11/08/2022]
Abstract
Efficient and safe access to targeted therapeutic sites is a universal challenge in minimally invasive medical intervention. Percutaneous and transluminal needle insertion is often performed blindly and requires significant user skill and experience to avoid complications associated with the damage of underlying tissues or organs. Here, we report on the advancement of a safer needle with a radial mechanical clutch, which is designed to prevent overshoot injuries through the automatic stopping of the needle once a target cavity is reached. The stylet-mounted clutch system is inexpensive to manufacture and compatible with standard hypodermic or endoscopic needles, and therefore can be adapted to achieve safe access in a myriad of minimally invasive procedures, including targeted drug delivery, at-home and in-hospital intravenous access, laparoscopic and endo- and trans-luminal interventions. Here, we demonstrate the clutch needle design optimization and illustrate its potential for rapid and safe minimally invasive cannulation.
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Affiliation(s)
- Eoin D O'Cearbhaill
- Center for Nanomedicine, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Cambridge, MA 02115, USA
- Harvard - MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
- School of Mechanical and Materials Engineering, UCD Centre for Biomedical Engineering, and UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
- Harvard Medical School, Boston, MA 02115
| | - Bryan Laulicht
- Center for Nanomedicine, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Cambridge, MA 02115, USA
- Harvard - MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
- Harvard Medical School, Boston, MA 02115
| | - Niamh Mitchell
- School of Mechanical and Materials Engineering, UCD Centre for Biomedical Engineering, and UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - Lawrence Yu
- Center for Nanomedicine, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Cambridge, MA 02115, USA
- Harvard - MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Michael Valic
- Center for Nanomedicine, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Cambridge, MA 02115, USA
- Harvard - MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Peter Masiakos
- Harvard Medical School, Boston, MA 02115
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA 02114
| | - Jeffrey M Karp
- Center for Nanomedicine, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Cambridge, MA 02115, USA
- Harvard - MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA
- Harvard Medical School, Boston, MA 02115
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, 02139, USA
- Harvard Stem Cell Institute, 1350 Massachusetts Avenue, Cambridge, Massachusetts 02138, USA
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Affiliation(s)
| | - Daniel R Obaid
- Swansea University Medical School and Morriston Cardiac Centre, Swansea, UK
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Turi ZG. Moving beyond Seldinger, a vascular access and closure smorgasbord, "safe zone" or not. Catheter Cardiovasc Interv 2018; 91:33-34. [PMID: 29314636 DOI: 10.1002/ccd.27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/09/2022]
Abstract
This paper describes a quality improvement initiative featuring the adoption of multiple access and closure techniques to assess "real world" outcomes. Although the study does not provide a scientific evidence base, it does highlight the changing platforms being adopted. Radial, micropuncture, and image guided access will hopefully become near universal in the coming decade.
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Affiliation(s)
- Zoltan G Turi
- Division of Cardiology, Hackensack University Medical Center, and Department of Cardiology, Seton Hall Hackensack Meridian School of Medicine, Hackensack, New Jersey
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