PAUT Procedure - MRU Adsorber PCI Rev. 0 (Thickness 83-88 Mm)
PCI procedure complication
-
Upload
dad-dr-m-ramadan -
Category
Education
-
view
588 -
download
1
Transcript of PCI procedure complication
![Page 1: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/1.jpg)
PCI COMPLICAIONSPCI COMPLICAIONS
BYDR Mohamed Ramadan, PhD
Consultant Intervention Cardiologist
![Page 2: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/2.jpg)
STATISTICSSTATISTICS
Over 2 million PCI procedures worldwide
Angiographic success rate of 90-95%
Overall complication rate 1-5%
![Page 3: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/3.jpg)
Successful PCISuccessful PCI
PCI performance is defined in terms of procedural success which identifies anatomical (or angiographic) success, (the enlargement of an epicardial vessel to a minimum luminal diameter of <10% stenosis or as near to 0% as possible, and TIMI 3 flow), without clinical complications
![Page 4: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/4.jpg)
The assessment that takes place in order to judge the feasibility for PCI is essentially one based on a combination of individualized risk/benefit analysis, lesion/technical and patient/co-morbid characteristics
Aim: to identify those at highest risk
![Page 5: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/5.jpg)
Patient clinical characteristics,Patient clinical characteristics,carrying increased riskcarrying increased risk
Advanced age Urgent or unscheduled intervention Hemodynamic instability Heart failure Renal insufficiency Diabetes mellitus Electrolyte imbalance Arrhythmia
![Page 6: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/6.jpg)
Procedure complication categoryProcedure complication category
1. Death (related to the procedure, regardless of mechanism)
2. Stroke3. MI (related to the procedure, regardless of
mechanism)4. Ischemia requiring emergency CABG5. Vascular access site complication6. Contrast agent nephropathy7. Excessive bleeding, requiring treatment8. Other (such as coronary perforation and
tamponade)
![Page 7: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/7.jpg)
© 201
6 Europa
Dig
ital & P
ublishing. A
ll rights res erved.
![Page 8: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/8.jpg)
© 201
6 Europa
Dig
ital & P
ublishing. A
ll rights res erved.
![Page 9: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/9.jpg)
© 201
6 Europa
Dig
ital & P
ublishing. A
ll rights res erved.
![Page 10: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/10.jpg)
Complications from femoral Complications from femoral access for PCIaccess for PCI
Retroperitoneal hemorrhage Pseudo aneurysm AV fistula Infection Hematoma Neuropraxia Lower limb ischemia (thrombosis or
embolism) Dissection
![Page 11: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/11.jpg)
Predictors of complications Predictors of complications relating to vascular accessrelating to vascular access
Female gender Advanced age Small body surface area Prior instrumentation Anticoagulation Peripheral vascular disease Diabetes Mellitus Suboptimal technique (puncture and closure)
![Page 12: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/12.jpg)
© 201
6 Europa
Dig
ital & P
ublishing. A
ll rights res erved.
The aim should be to puncture the common femoral artery within a target zone , 5 mm to 14 mm inferior to the centre of the femoral head
![Page 13: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/13.jpg)
LESION (ANGIOGRAPHIC) LESION (ANGIOGRAPHIC) CHARACTERISTICSCHARACTERISTICS
Calcification, tortuosity (angulation >45 degrees), left main, bifurcation subsets, degenerated saphenous vein graft, chronic total occlusion and multivessel disease all feature prominently in the diminished technical success of a procedure and the ability to be associated with complications
![Page 14: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/14.jpg)
![Page 15: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/15.jpg)
Coronary DissectionCoronary Dissection
Coronary dissection involves plaque fracture,intimal splitting and localized tear which mayextend to the media for varying distance
![Page 16: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/16.jpg)
![Page 17: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/17.jpg)
Left main artery dissection
![Page 18: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/18.jpg)
![Page 19: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/19.jpg)
![Page 20: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/20.jpg)
Perforation is an anatomical breach in the integrity of the tunica adventitia of an epicardial artery leading to extravasation of blood, either into the myocardium, pericardium or a cardiac chamber
Coronary Perforation
![Page 21: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/21.jpg)
![Page 22: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/22.jpg)
![Page 23: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/23.jpg)
![Page 24: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/24.jpg)
![Page 25: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/25.jpg)
![Page 26: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/26.jpg)
![Page 27: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/27.jpg)
![Page 28: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/28.jpg)
![Page 29: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/29.jpg)
![Page 30: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/30.jpg)
![Page 31: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/31.jpg)
After Balloon Inflation For more than 10 mins
![Page 32: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/32.jpg)
![Page 33: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/33.jpg)
![Page 34: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/34.jpg)
![Page 35: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/35.jpg)
Indications for emergency Indications for emergency cardiac surgery following PCIcardiac surgery following PCI
Extensive coronary dissection (54%) Perforation/tamponade (20%) Recurrent acute vessel closure (20%) Hemodynamic instability (3%) Aortic dissection (2%) Guide wire fracture (1%)
![Page 36: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/36.jpg)
© 201
6 Europa
Dig
ital & P
ublishing. A
ll rights res erved.
![Page 37: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/37.jpg)
© 201
6 Europa
Dig
ital & P
ublishing. A
ll rights res erved.
How can you minimize PCI complications?
![Page 38: PCI procedure complication](https://reader031.fdocuments.us/reader031/viewer/2022021923/58ee4c621a28ab65378b4595/html5/thumbnails/38.jpg)