Cath Lab Digest - October 2007 - (Page 39)

OCTOBER 2007 TECHNOLOGY SNAPSHOT 39 Experience with a New Workhorse Guidewire Cath Lab Digest talks to both a physician and a technologist about their experience with the Runthrough NS (Terumo Interventional Systems, Somerset, New Jersey). Joseph De Gregorio, MD, Chief of Interventional Cardiology and Interventional Research, Hackensack University Medical Center, Hackensack, New Jersey Can you tell us about the cath lab at Hackensack University Medical Center? De Gregorio: Hackensack is the fourth-largest medical center in the country and one of the top fifty rated cardiac centers in the U.S. We perform over 3,000 coronary interventions a year along with a significant number of peripheral procedures. Tell us about your experience with the Runthrough NS (nitinol stainless) guidewire. De Gregorio: I have been using it for the past few months and have been able to evaluate it extensively in some complex cases. I like its deliverability and torqueability. To me, the wire’s greatest asset is that it is not only very deliverable but that it also provides good support. There are cases where you might have to use a soft hydrophilic wire to reach a difficult area, but the tradeoff is that the wire may not provide the support you need to deliver your devices. You may end up having to switch out for a wire that gives you that support. With the Runthrough, having to switch wires may happen less frequently. What have you seen happening with the development of guidewire technology? De Gregorio: For quite some time, there was not much happening in regards to guidewire innovations and new technology. A few years ago, we got the Asahi wires from Japan, which now come to us through Abbott. The Asahi wires were a breakthrough, but the advantages were mostly in the realm of total occlusions. There hasn’t been anything really innovative on the market for a general workhorse wire in a very long time. Figure 1. The Runthrough NS. Can you share a recent case with us where you have used the Runthrough? De Gregorio: I have used it in some difficult situations. The one case in particular that comes to mind is one where I had to access a posterior lateral branch of the right coronary artery through a vein graft which was attached to the right posterior descending artery (PDA). What I needed to do was access the saphenous vein graft with a multipurpose guide and wire down to the PDA where it connected. I then had to retrogradely go up the PDA, around the point where it bifurcates in the distal RCA with the posterior lateral branch, and put the wire in the distal posterior lateral branch. I had to treat the area of the takeoff of the posterior lateral branch at the bifurcation, so I had to deliver balloons and subsequently a stent to that area. The wire performed very well. I was surprised at how easily I was able to deliver it to that segment of artery, and that it actually gave very good support in being able to maneuver devices to that segment. Have you noticed any time savings from not having to change out wires? De Gregorio: Yes, absolutely. That’s part of what makes this a favorable wire. As I noted, one of the things we have had to do in the past to access difficult areas is go in with a less supportive wire, and then switch it out to a different wire so we have the necessary support. With the Runthrough, however, it has been easier to deliver devices to a difficult area without always having to add a second wire or switch out for a stiffer wire. We can then work safely over the original wire, because it usually gives adequate support. Since this is a general workhorse wire, how does it affect your use of specialty wires? De Gregorio: Specialty wires are for the more complex and difficult cases such as total occlusions and maybe other areas that are very tortuous or calcified. You will always need specialty wires. With the current workhorse wires, you may have to delve more often into certain specialty wires, whereas with the Runthrough, it will happen less often. ■ Dr. De Gregorio can be contacted at: jdegregorio@humed.com Charlie Baker, Jr., RT, Hackensack University Medical Center Hackensack, New Jersey Can you tell us about the staff mix at your lab? Baker, Jr.: We have 6 labs here at Hackensack and do anything from diagnostic and interventional coronary to, to cerebral and all other sorts of peripheral procedures and interventions, as well as IVC filters. We have 9 CVT/RTs, 16 RNs and 12 monitor techs. Each profession has their own set job descriptions. There is some crossing over, but for the most part, the monitor techs are pretty much always behind the monitor, doing patient hemodynamics as well as billing forms, whereas the nurses are dealing with patient needs, medications and charting, while the CVT/RT is working at the table with the physician. How much do physicians rely on your expertise and knowledge? Baker, Jr.: We are right there by their side, so a lot of physicians look to us as their assistant, so to speak, to recommend or suggest anything. Remember, we are the ones involved

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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