Predictive Factors of Survival for Intra-aortic Balloon Pump in Acute Myocardial Infarction Treated with Angioplasty

BACKGROUND AND OBJECTIVES: Intra-aortic balloon pumps (IABP) are useful tools for hemodynamic support in patients with hemodynamic instability or cardiogenic shock due to acute myocardial infarction (AMI). The purpose of this study was to examine the clinical characteristics and outcomes in patients with AMI who underwent IABP support, and to identify predictors of in-hospital mortality. SUBJECTS AND METHODS: We retrospectively analyzed 46 consecutive patients with an acute myocardial infarction, who underwent primary or rescue percutaneous coronary intervention, with IABP support, between March 1997 and June 2002. The patients were divided into survivors and non-survivors. We compared the clinical characteristics, hemodynamic parameters and therapeutic outcomes between the two groups, and assessed the clinical and angiographic predictors of in-hospital mortality. RESULTS: The overall survival rate was 39%. The indications of IABP support were cardiogenic shock (50%), unstable hemodynamics during coronary angioplasty (13%) and high risk intervention (35%). There were no significant differences in clinical diagnosis, infarct location, Killips classification, risk factors, ejection fraction, pain to balloon time, clinical indications for IABP, extents of coronary artery disease and left ventricular end diastolic pressure between the two groups. The survival group was younger than the non-survival group (p=0.04), and the TIMI III flow after PCI was more frequent in the survival group (p=0.01). The TIMI III flow was a predictor of in-hospital mortality (p=0.01). CONCLUSION: The predictive factor of survival following IABP was the TIMI III flow in patients with AMI who underwent primary or rescue PCI.

The Study of Branching Anomaly and Tortuosity of Radial Artery for Trans-Radial Coronary Procedure

BACKGROUND AND PURPOSE: The radial artery has currently been regarded as a useful vascular access site for coronary procedures. We want to evaluate the incidence and clinical significance of anomalous branching pattern and tortuosity of radial artery. MATERIALS AND METHOD: From May 1997 to May 1999, retrograde radial artery angiography was performed in 1191 cases. Branching anomaly and tortuosity of upper extremity artery, procedure times and local vascular complications were analyzed. RESULTS: 1) Anomalous radial arterial branching was found in 3.2%. Most common one was high origin of the radial artery (2.4%). 2) Tortuosity of radial artery was found in 4.2%. Most common tortuosity were S shape in 1.8% and omega shape in 1.8% of cases. 3) Cross over to other artery, radial artery occlusion and perforation occurred in 24 cases, 6 cases and 4 cases, respectively. Prolonged procedure times, crossover to other artery and radial artery perforation was related with tortuosity of radial artery, not with anomalous branching. CONCLUSION: The incidence in branching anomaly and tortuosity of radial artery was not frequent in our study. Radial artery tortuosity was associated with old age, prolonged procedure time and radial artery perforation. In selected cases, pre- or intra-procedural angiographic assessment of radial artery might be helpful in performing safe procedure.

The changes of radial arterial diameter and procedural outcomes of repeated-use radial artery in transradial

BACKGROUND AND OBJECTIVES: Practical concerns about transradial approach are increasing in consideration of high procedural success rate, low local complications, and patient's convenience. There was no available data about repeated-use of radial artery for coronary procedures. We evaluate the changes of radial arterial diameter and procedural outcomes of repeated transradial procedure. MATERIALS AND METHOD: Of consecutive 1771 transradial coronary procedures, 117 patients received repeated transradial procedures through the same radial artery. Radial arterial diameter, vascular access time and procedural outcomes were evaluated in between the group of first-use and repeated-use of radial artery. RESULTS: Among 117 patients of second transradial coronary procedure in the repeated-use group, 47 patients (41.6%) underwent coronary intervention and 66 patients (58.4%) underwent coronary angiography. The right radial approach was used in 82.9% of the cases. There was no significant difference in radial artery mean diameter between pre-procedure and 1 day after procedure in patients with first-use and repeated-use group. There was no significant change of radial arterial diameter after first-use depending on the SAR (the ratio of sheath outer diameter to radial artery inner diameter). However, after repeated-use of radial artery, there was significant reduction of radial arterial diameter 1 day after procedure in the patients with SAR more than 0.9 (p<0.05). In repeated-use group, the mean radial arterial diameter was 2.63 +/- 0.35mm mm before the procedure and 2.51 +/- 0.29mm during follow-up (136 +/- 123 days) (p<0.05). There was no significant difference of the vascular access time between the first-use and repeated-use procedures (2.9+/-3.1 vs 3.3+/-3.6 minutes, p<0.05). The procedural success and vascular complication rate of repeated-use of radial artery were as similar to those of the first-use, but total occlusion of radial artery was higher in the repeated-use group (2.6% vs 0.7%, p<0.05). CONCLUSION: The diameter of radial artery after transradial procedures was significantly reduced during follow-up and the incidence of asymptomatic radial artery occlusion was more frequent after repeated-use. However, repeated-use of radial artery was feasible in most patients with high procedural success rate and low vascular complications.

The Experience of Trans-Radial Coronary Intervention in Wonju

Background and objective: With recent advances in technology and miniaturization of equipment, the trans-radial approach has currently been advocated as an alternative method for coronary angioplasty. We tried to evaluate the feasibility of trans-radial coronary intervention (TRCI). MATERIALS AND METHODS: 138 Allen-positive cases (159 lesions) underwent TRCI with currently available devices. Mean age was 60.8 + 9.2 years and 67% were men. Clinical diagnoses were AMI in 49, unstable angina in 48, stable angina in 28, OMI in 9 and 4 cases of restenotic lesions. RESULTS: Technical success was achieved in 124 cases (89.9%). Among the 124 successful cases, left and right radial arteries were used in 93 cases (110 lesions) and in 31 cases (35 lesions), respectively. The size of the guiding catheter used for TRCI was 6 Fr in 100 cases (80.7%), 7 Fr in 21 cases (16.9%), and 8 Fr in 3 cases (2.4%). Stent implantation and rotational atherectomy were successfully performed in 75 cases (86 lesions) and 10 cases (12 lesions), respectively. The reasons of failure were puncture failure in 2 cases, guiding failure in 6 cases, guide-wire crossing failure in 4 cases who had chronic total occlusion, and suboptimal results in 2 cases. Major cardiac complications occurred in 3 cases, one case of each cardiac death, nonfatal myocardial infarction and coronary artery perforation. No major entry site complications were seen with only non-ischemic radial artery occlusions in 3 cases (2.8%). CONCLUSION: TRCI is feasible with currently available devices and is safe with a relatively acceptable procedural success rate and low complications.

Usefulness of Trans-Radial Coronary Angiography in Wonju

BACKGROUND AND OBJECTIVES: Recent data about trans-radial approach showed its usefulness in achieving the high procedural success rate and low local complications even though the size of the radial artery is small compared to that of the femoral artery. Therefore, we want to evaluate the size of the radial artery and the feasibility of the trans-radial coronary angiography as a routine technique. MATERIALS AND METHOD: Trans-radial coronary angiography (TRCA) was successful in 619 cases. The size of the radial artery was measured using 2D-ultrasonography. TRCA was tried with 4 Fr catheters. We divided the cases into two groups; early phase, 106 cases and late phase, 513 cases and compared the procedure time, catheter number used, and complications between 2 groups. RESULTS: The size of the radial artery was 2.7+/-0.4 mm in diameter and this of the men was larger than that of women (p 0.05). TRCA was performed successfully in 513 cases among 521 cases of late phase (98.5%) and crossover to femoral artery occurred in 8 cases (1.5%). The fluoroscopic time and total procedure time of the late phase (6.5+/-4.0 min, 22.9+/-11.3 min) were significantly lower than those of early phase (11.5+/-6.3 min, 31.2+/-13.7 min) (p<0.01). The average number of catheters used for coronary angiography was 1.8+/-1.0. There were 6 cases (1%) of radial artery occlusion and 1 case (0.2%) of radial artery perforation without hand ischemia. CONCLUSION: Based on the adequate size of the radial artery, high success rate and low complications, TRCA might be a safe and become a routine diagnostic technique.

Retrograde Endotracheal Intubation Using a Guide Wire in a Pediatric Patient / 대한마취과학회지

An 8-year-old male with ankylosis of both temporomandibular joints was scheduled for an elective condylectomy. Physical examination revealed a relatively healthy appearing child, weighing 25 kg, with 5-7mm of maximal oral opening. The EKG, chest x-ray and laboratory data were within normal limits. An attempt at local infiltration after injection of droperidol 2.5 mg for retrograde technique was unsuccessful. Subsequently, anesthesia was induced with thiopental, halothane, nitrous oxide and oxygen via a mask. The cricothyroid membrane was punctured with an 18 gauge Touhy needle. After confirmation of the intratracheal position by aspiration of air into a fluid filled syringe, a flexible guide wire tip of CVP catheter (VYGON) was threaded via this needle superiorly into the posterior pharynx through the larynx. After introduction of the guide wire into right naris, the nasotracheal tube was threaded over the wire, and the tip of the tube in the trachea at the site of the cricothyroid membrane puncture was confirmed by palpation and visual inspection. The nasotracheal tube was advaned further into the trachea after removal of the guide wire. Auscultation confirmed appropriate intratracheal placement.