Fail Safe Guide to Access Routes and Guide Catheters in Acutely Unwell Patients - Dr. Amarjit Sethi

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Summary


Amarjit Sethi outlines options for vascular access and guiding catheters in specific situations in ACS patients

  • How to deal with complex and high-risk patients
    • Cariogenic shock
    • Multi vessel disease
    • Last remaining coronary artery
    • Large area of myocardium at risk
    • Impaired systolic function
  • How to prepare your access with regards to specific considerations
    • Central venous access - delivery of inotropes, temporary pacing wires
    • Multiple arterial access - circulatory support devices such as IABP
    • Radial versus femoral access
  • How to limit access-related complications
  • How to choose your guide catheter for specific situations
    • Femoral or radial
    • French size (5F guides helpful with small radial arteries but limits the amount of equipment that can be used - i.e thrombus aspiration, rotablation)
    • Aortic width
    • Lesion location and characteristics (distal lesion, tortuously, calcification)
    • Side holes or not
    • Fitting for the coronary
    • Special scenarios - IMA for LIMA PCI, MPA for vein-graft
  • Get comfortable with your choice of guide catheter for most situations ("workhorse guide catheter")


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