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Brachiocephalic interventions
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Femoral access is achieved and heparin administered (100 U/kg). An activated clotting time (ACT) is obtained and maintained at >250 seconds. The same size femoral sheath access sheath is placed as that anticipated for the procedure, usually either 6-Fr or 7-Fr. A floppy tip guidewire is placed in the aortic arch and the image intensifier rotated into the LAO position to reflect the best angle achieved for viewing, as identified on the preoperative study. The cerebral catheter of choice is placed over the guidewire. Chapter 9 offers a discussion of carotid catheterization and Chapter 11 discusses carotid arteriography. The image intensifier is maintained in its fixed LAO position and the bony landmarks may be used to guide vessel cannulation. The cerebral catheter is placed in the common carotid artery origin. A hydrophilic, steerable guidewire is advanced through the catheter and into the mid- to distal common carotid artery. The location of the carotid bifurcation can often be identified on plain fluoroscopy due to the presence of vessel calcification. The guidewire is not permitted to pass into the bifurcation. The cerebral catheter is advanced so that its tip is well seeded in the common carotid artery. A road map of the carotid bifurcation is performed (Figure 21.4). The position of the image intensifier may require adjustment to obtain the best image showing the bifurcation and the separation of the internal and external carotid arteries. Occasionally, a lateral view is required. Multiple views may be needed to best open the carotid bifurcation.
Thrombosis, heparin and laboratory monitoring of heparin therapy
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
In settings such as the cardiac operating room or catheter lab, where such delays may be to the detriment of the patient, results are required more promptly. The activated clotting time (ACT) is one test that provides comparable information to the APTT in a much shorter time. The ACT has no specimen preparation, improving the turnaround time for obtaining results. Whole blood is used and is injected directly into a tube containing an activator. A simple clot detection system times clot formation and the microprocessor-controlled solid-state electronics ensure accuracy of results. The test is designed to be used as a bedside monitoring test (see Chapter 6).
Carotid angioplasty and stenting
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Robert G. Molnar, Baraa Zuhaili
or an anticoagulant of choice. Activated clotting time (ACT) levels should be between 250 and 300 seconds. A pigtail catheter is inserted into the ascending aortic arch and the image intensifier is then rotated until the catheter is visualized in its widest plane. Most textbooks report using a standard 30-degree left anterior oblique view; however, occasionally the best angle may be up to 50 degrees. This becomes very important because some patients with an aortic arch that appears to be a steep type II at 30 degrees may be a type I or mild type II at a steeper angle (e.g., >30 degrees).
Feasibility of distal transradial access for coronary angiography and percutaneous coronary intervention: an observational and prospective study in a Latin-American Centre
Published in Acta Cardiologica, 2023
Héctor Hugo Escutia-Cuevas, Marco Alcantara Melendez, Arnoldo Santos Jiménez-Valverde, Gregorio Zaragoza-Rodriguez, Antonio Vargas-Cruz, Juan Francisco Garcia-Garcia, Bayardo Antonio Ordonez-Salazar, Antonio Flores-Morgado, Guillermo Orozco Guerra, Diego Alvaro Renteria-Valencia
With prior consent signed by the patient and/or responsible person. The puncture site was infiltrated with 2% lidocaine (1–2 mL). 5000 IU unfractionated heparin was administered intravenously after insertion of the distal radial sheath, and in case of requiring percutaneous coronary intervention, a dose of 80–110 IU/kg/hour was completed. In the case of long procedures, activated clotting time (ACT) control was required, with values between 300 and 350 s. The following vasodilators were used initially as intra-arterial bolus: 200 mcg of nitroglycerine (which was excluded in the case of hypotension) and 250 mcg of levosimendan. In case of pain attributed to radial spasm, a maximum dose of 1 mcg/kg of intravenous Fentanyl was administered in combination with nitroglycerine and levosimendan in the same dose as first. No other sedatives or vasodilator drugs were used. After radial sheath removal, the heparin infusion was continued in case of evidence of intracoronary thrombus.
FlowTriever Retrieval System for the treatment of pulmonary embolism: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Vivian L. Bishay, Omosalewa Adenikinju, Rachel Todd
AC with heparin is recommended per routine practice to prevent catheter thrombosis. Activated clotting time (ACT) can be checked to maintain appropriate therapeutic goals. The aspiration guide catheter, which is available in 16, 20, and 24 French lumen sizes is advanced over a stiff 0.035” guidewire to the level of the right or left main pulmonary artery just proximal to the thrombus. Initial crossing of the right heart into the pulmonary artery should be done with a balloon-tipped or pigtail-shaped catheter to avoid tracking the guidewire and more importantly the large bore catheter through cordae tendineae. The aspiration guide-catheter should be tracked slowly across the right heart and retracted back to the inferior vena cava if the patient experiences rhythm change or if resistance is felt. The most recent version of the 24 French guide has increased flexibility from the previous generation and is intended to provide superior trackability through the right heart. The aspiration guide-catheter can often be used without the aid of disks for rapid removal of large central clot. A 20 French curved catheter is also available, which has a 260-degree bend at the tip. This catheter can be telescoped through the 24 French allowing for steerability that can improve navigation of left pulmonary artery anatomy as well as the targeting of clot in transit.
An Efficacy Comparison of Two Hemostatic Agents in a Porcine Liver Bleeding Model: Gelatin/Thrombin Flowable Matrix versus Collagen/Thrombin Powder
Published in Journal of Investigative Surgery, 2020
Paul Slezak, Claudia Keibl, Heinz Redl, Dirk Labahn, Heinz Gulle
Animals were placed in dorsal recumbency and, following insertion of jugular, carotid, and urinary catheters, a median laparotomy was performed and the liver was exposed. A baseline measurement of activated clotting time (ACT) was performed. Following preparation, a 10-mm diameter biopsy punch was used to create lesions ∼4–6 mm deep in the liver. Initial blood loss was quantified as described below, and lesions were excluded from the study if the bleeding rate was ≥20 mL/min. Lesions with bleeding rates below 20 mL/min were treated topically following an alternating pattern (ABAB) scheme with either SmGM (Floseal; Baxter Healthcare SA, Zurich, Switzerland) or PCCT (Hemoblast; Biom’up, Saint-Priest, France).