Cath Lab Digest - March 2008 - (Page 62)

62 PRODUCT SPOTLIGHT MARCH 2008 Experience with a New Guidewire: The Terumo Runthrough NS Cath Lab Digest talks with Samin Sharma, MD, FACC, Co-Director of the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, and Director of Interventional Cardiology and the Cardiac Catheterization Lab, Mount Sinai Hospital, New York, New York about his experience with the Runthrough NS (Terumo Interventional Systems, Somerset, New Jersey). our patient population is very high risk. One of the important reasons for our continued growth is extremely good success in these high-risk interventions. In view of concerns about reimbursements, very few labs do ambulatory interventions (same-day discharge), while about 22% of our cases are discharged on the same day. It’s actually good for the institution and helps a great deal, since we don’t have to worry about having beds for each patient. Mount Sinai has maintained a very impressive track record in the New York area, with high efficiency, good work ethics and excellent procedural outcomes. We believe that the higher the volume for each physician, the better is the outcome. We follow numerous set protocols in the cath lab and do the same thing every time, a key factor that has led to the present success of our cath lab. What are your criteria for same-day discharge? Do you use radial procedures? We do about 10% of our procedures with radial access. Two of our voluntary attending do a large percentage (>70%) of their cases via radial approach. The criteria for the same-day discharge are successful interventions, no procedural complications, and no issues in 4-8 hours post-procedure observations and follow-up lab tests. How long have you been using the Runthrough NS? Figure 1. The Runthrough NS (Terumo Interventional Systems, Somerset, New Jersey). Can you tell us about the cath lab at Mount Sinai? Mount Sinai has a very busy cath lab. In 2003, we did 2,750 interventional procedures (with a total cath volume of 9400). In 2006, we crossed the 5,000 mark (5,174 interventional procedures and total cath volume >14,000), which makes Mount Sinai one of the largest four or five labs in the country to do 5000 interventions. In 2007, we did 4,908 interventional procedures with a total cath volume >14,500. So, in both 2006 and 2007 combined, a total of 5000+ interventional cases each year were done at Mount Sinai cath lab, all in 4.5 rooms (as one room is shared with pediatric cardiology). We have 5 fulltime interventionalists and 8 parttime interventionalists as well. The cath lab staff has grown over the last five years, with current number of employees being over 125 (of which 46 nurses and 8 nurse practitioners). Being a tertiary referral center, For about 2-3 months. For last 10 years, the Balance Middleweight (BMW; [Guidant] Abbott Vascular, Redwood City, CA) has been our main workhorse wire, used in 70% of our cases. Even now, the BMW remains our most-used wire. Aside from the Runthrough, the only wires we have added in the past few years are the Miracle Bros (Asahi) wires for total occlusions and Fielder wire for angulated lesions from Abbott Vascular. We commonly use these specialty wires for tortuous, angulated and total/subtotal coronary lesions. Prior to that, we used to use Boston Scientific Choice and Luge wires (Natick, MA) and Guidant’s Whisper & Pilot wires, but these are now largely replaced with the Fielder wire, which is a very good Abbott wire for these complex lesions. All of this is to say that prior to adopting the Runthrough, we were actually very content with our guidewire situation. We knew that the Runthrough wire was available, but we were not ready to change our wire choice. In attending few of the national meetings, however, I heard all the talk about the Runthrough wire and then was convinced to give it a try. It has worked out very well. We have had a good experience with Runthrough wire in past few months. Prior to the Runthrough, we would use combination of two wires for angulated lesions and tortuous vessels: BMW and Fielder. The BMW is a workhorse wire that gives you good support and the Fielder wire can go through angulated lesions, but may not give that good support. The Runthrough NS now allows us to go through angulated, tortuous lesions and yet it also provides good support for advancement in difficult situations. Usually, you don’t need much support when you are inserting a stent, but in some angulated lesions, upward-curving vein grafts, shepherd’s crook right coronary arteries and tortuous circumflex arteries, you may need an extra body support wire, and the Runthrough NS gives good support for that purpose. Has it affected your use of specialty wires? Yes, I know that some interventionalists talk about the Runthrough NS being a workhorse wire, and indeed it has the quality of a specialty wire in giving good support and is able to advance the devices in angulated lesions. In tortuous or angulated lesions, if we need some support, instead of using Fielder wire, we can use only the Runthrough NS wire. Still, we have not yet replaced the BMW in our lab. The BMW is still the main workhorse wire at this time because of its continued success, our comfort level and excellent track record of its use over 100,000 times with only two cases of wire perforations. Once I get more comfortable with the Runthrough, we may start using it more and more. The real difference I felt in using the Runthrough wire was its ability to steer 1:1 and the fact that it gave great support for the delivery of stents and balloons in difficult cases. Can you provide more detail about the types of cases in which you may consider using the Runthrough? Vein grafts (particularly the vein graft to circumflex branches) and native diagonal branches, because these vessels make an angle after their origin (going up and then turning down in course). As a result, in

Table of Contents Feed for the Digital Edition of Cath Lab Digest - March 2008

Cath Lab Digest - March 2008 Are You Being Paid Fair Market Value in 2008? A Cardiac Cath Lab Professionals Survey by Cath Lab Digest and the Society of Invasive Cardiovascular Professionals Saint Joseph’s Hospital Invasive Imaging Tools for Optimizing Coronary Stent Deployment Contents Clinical Editor’s Corner A Workflow Revolution in Cath Lab Reporting Advantages of a New Digital Lab at Baystate Medical Center Cardiac Computed Tomography: What Does it Mean for the Cath Lab? The Latest in Cardiac Magnetic Resonance Imaging (MRI) Cellular Cardiomyoplasty and Cardiac Regeneration Intravascular Ultrasound in the Cath Lab: A Powerful — and Underutilized — Tool to Improve Patient Outcomes The Stentplus™ Patient Success Program Cardiac Cath Lab Clutter — or, Spring into Action! Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relevant Issues Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab What Do You Think? Experience with a New Guidewire: The Terumo Runthrough NS The Ostial Pro™ Stent Positioning System: Perfecting Aorto-Ostial Stent Placement Precious Minutes The Ten-Minute Interview with…Mark Bowles, BSN, CCRN Vascular Care in the Cath Lab: Planning a Smooth Transition Cath Laughs CMS 2008 OPPS Final Rule Review An Extensive Set of Review Courses for the CCI Basic Science, Non-Invasive Echocardiography and Vascular, and ARDMS Ultrasound Exams Meetings Calendar CEU Education Center Clinical & Industry News STEMI Interventions Classifieds Advertisers Index

Cath Lab Digest - March 2008

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