Cath Lab Digest - April 2008 - (Page 1)

Predicting Stent Thrombosis Using A Clinical Risk Score by Kenneth Baran, MD Page 30 Clinical Editor’s Corner: Morton Kern, MD New Ideas from Cardiac Cath Lab Staff Page 4 www.cathlabdigest.com A Product, News and Clinical Update for the Cardiac Catheterization Laboratory Specialist Cath Lab Spotlight NEW TECHNOLOGY Orbital Atherectomy: A new treatment for complex peripheral arterial disease Cath Lab Digest talks with Raj Dave, MD, Director, Endovascular Medicine, Pinnacle Health/Harrisburg Hospital, Harrisburg, Pennsylvania The cardiac cath lab/interventional radiology crew. Back, from left: Inger Alt, RN, John Kennedy, MD, Carol Usem, CRT, Peter Alt, RN, Allison Wheeler, Nurse Intern, Helen Carrico, RN, Robert Flannagan, RN. Reclining: Ghadija Perlman, CRT. Front left: Paula Rabbit, RN, Jim Stokes, CRT. Kaiser San Rafael Medical Center Peter Alt, RN, San Rafael, California What is the size of your cath lab facility and number of staff members? Our facility has 1 dual-use lab. It functions both as a cardiac cath lab and an interventional radiology (IR) lab. Currently, our staff consists of: • 8 part time registered nurses (RNs) • 3 radiology technologists (RTs) • 1 nurse practitioner (NP) • 4 diagnostic cardiologists on a rotating basis (in-house) • 7 interventional cardiologists on a rotating basis (from San Francisco Kaiser) • 1 full-time interventional radiologist (in-house) • 1 vascular surgeon who also does frequent IR procedures (in-house) continued on page 18 What is orbital atherectomy and how does it differ from rotational atherectomy? Orbital atherectomy is a promising new methodology for treating symptomatic peripheral arterial disease within the major and branch arteries of the leg. It is performed with the Diamondback 360° Orbital Atherectomy System (Cardiovascular Systems, Inc., St. Paul, MN), a new atherectomy device utilizing an orbiting eccentric diamond-coated crown on the end of a drive shaft powered by a pneumatic drive console (Figures 1a and 1b). The shaft and crown are advanced over a preplaced 0.014” proprietary guidewire, the ViperWire™. The orbital motion of the crown removes plaque from within a diseased arterial segment; as the crown orbits, the debulking area increases, and with increments in speed, the area increases further (Figure 2). For comparison, rotational atherectomy uses a concentrically rotating burr, so luminal gain is as large as the burr size being utilized. Changes in rotational speed of the burr do not result in a significant increase in debulking area as happens during orbital atherectomy. If a larger lumen is desired, a larger burr must be deployed. continued on page 8 NEW STAFF Ask the Clinical Instructor A Q&A column for those new to the cath lab Questions are answered by: Todd Ginapp, EMT-P, RCIS, FSICP Todd is the Cardiology Manager for Memorial Hermann Southeast in Houston, Texas. He also teaches an online RCIS Review course for Spokane Community College, in Spokane, Washington, and regularly presents with RCIS Review Courses. April 2008 vol.16, no.4 “We have some physicians that do unusual things when trying to analyze valves. What is the correct way?” — RCIS Online student Part I. There really isn’t a ‘right’ way to do it, as long as you get the proper information. However, there are some standard methodologies. The main valves we interrogate are the aortic and mitral valves. With the advancing technology of echocardiography, detailed valve analysis is no longer commonplace in the cath lab. The article continues on page 14 http://www.cathlabdigest.com

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

Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

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