Table Of ContentCatheter-Based Cardiovascular
Interventions
Peter Lanzer
Editor
Catheter-Based
Cardiovascular
Interventions
A Knowledge-Based Approach
Editor
Dr. Peter Lanzer
Department of Internal Medicine
Division of Cardiovascular Disease
Center of Internal Medicine
Clinic of Internal Medicine I
Health Care Center
Bitterfeld/Wolfen gGmbH
Bitterfeld-Wolfen
Germany
ISBN 978-3-642-27675-0 ISBN 978-3-642-27676-7 (eBook)
DOI 10.1007/978-3-642-27676-7
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2012939490
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“The fox knows many things,
but the hedgehog knows one big thing.”
Archilochus (c. 680 BC – c. 640 BC)
Preface
Since 1980 part of the training routines in interventional cardiology and vas-
cular medicine at St. Vincent’s, Indianapolis, was a review of angiograms.
Because my training took place during the pre-stent era poor post-angioplasty
outcomes were clearly visualized by angiography. In addition, because of the
large number of operators at St. Vincent’s and due to the high frequency of
complete anatomic revascularization attempts at that time the fellows turned
into ef fi cient readers of angiograms in a relatively short time span. After
reviewing hundreds of cine rolls and x-ray sheets three observations have
become obvious; fi rst , the differences in outcomes between operators were
striking; s econd , these differences were systematic and consistent; t hird , the
relationship between the length of interventional practice of individual opera-
tors and procedural outcome has not been straight forward.
With advancing reading skills some of us fellows have developed the habit
of reading the angiograms blinded to the operator. Surprisingly, the percent-
age of correct guesses was fairly high. Overall there seemed to be three main
categories of operators; experts, intermediates and less accomplished ones.
The hallmark of expert performance seemed to be high consistency of excel-
lent outcomes regardless of cases’ complexity. Among the experts at St.
Vincents two individuals seemed outstanding; Cass Pinkerton, cardiologist
and Don Schwarten, radiologist, both not only skilled operators and gifted
teachers but also great individuals. Of course we fellows were keen to model
our budding skills on theirs accomplished ones. Unfortunately, observing,
sharing and discussing cases did not seem to tell the full story; even worse,
there was no simple transfer of expertise as we have perhaps dreamed of at
the time.
The secrets of Cass’s and Don’s accomplished skills, their consistent
ef fi ciency, diligence, gentleness and elegance of approach kept puzzling me
for many years. Finally, a turning point came. A phone call to The Department
of Mathematics and Informatics at Freie Universität Berlin got me in touch
with Lutz Prechelt, professor of informatics at that institution. Subsequent,
collaboration with Prechelt has become instrumental in de fi ning the path of a
formal research into interventional expertise.
Looking back, it is hard to understand why it did take so long to pick up
on interventional expertise; the fundamental linkage between interventional
knowledge, judgment, decision making and psycho-motor skills available to
individual operators and in cases of experts based on many, many years of
deliberate practice seems now so obvious. Although in gifted individuals the
vii
viii Preface
interventional expertise can be gained tacitly, the increasing complexity of
catheter-based cardiovascular interventions in increasingly sicker and older
patients along with growing public demands concerning procedural ef fi ciency
and safety mandate a broad and consistent availability of high level interven-
tional expertise. To meet these challenges successfully, systematic research
into interventional skills, their explication, explicit teaching and implementa-
tion are required. Consequent recalibration of professional standards cannot
be based on efforts of individuals alone; it represents an urgent task of the
interventional community as a whole and requires an immediate and decisive
action. This textbook represents an early attempt to explicate interventional
expertise and to make it available to our readers, the future interventional
experts, and to all those who seek to raise professional standards and by doing
so to further improve treatment outcomes.
Peter Lanzer, M.D.
Editor-in-Chief
Contents
Part I Historical Background
1 Historical Account: Interventional Cardiology ........................ 3
Oliver Gaemperli and Thomas F. Lüscher
2 Historical Account: Cardiovascular
Interventional Radiology ............................................................ 15
Josef Rösch and Frederick S. Keller
3 Historical Account of Interventional Neuroradiology ............. 27
Eric R. Cohen, Philip M. Meyers, Sean D. Lavine,
and Randall T. Higashida
Part II Knowledge
4 Knowledge ................................................................................... 45
Michael Bishop
5 Knowledge and Its Transmission ............................................... 49
Tim Thornton
Part III Skills and Expertise
6 Cognitive Science: An Introduction .......................................... 61
Cleotilde Gonzalez
7 Cognitive Skills in Medicine ....................................................... 69
Halszka Jarodzka, Henny P.A. Boshuizen,
and Paul A. Kirschner
8 Psychomotor Skills ...................................................................... 87
Otmar Bock and Adam Dubrowski
9 Professional Expertise in Medicine ........................................... 97
Joe Causer and A. Mark Williams
10 Cognitive and Decision Making Skills in
Catheter-Based Cardiovascular Interventions ......................... 113
Peter Lanzer
ix
x Contents
11 Legal Expertise ............................................................................ 157
Alexander P.F. Ehlers, Christian Rybak, and Astrid Wenke
12 Development and Teaching of Complex
Skills in Invasive Procedures ...................................................... 173
Jeroen J.G. van Merriënboer and Irene Tjiam
13 Computer Simulation as Training
Tool for Coronary Interventions ................................................ 187
Wolfram Voelker
Part IV Diagnostic Modalities
14 Cardiovascular X-Ray Imaging:
Physics, Equipment and Techniques ......................................... 203
Arnold R. Cowen
15 Radiation Protection ................................................................... 261
Roshan Samuel Livingstone
16 Interventional X-ray coronary angiography ............................ 279
Peter Lanzer
17 Cerebral Angiography ................................................................ 303
Mark R. Harrigan
18 Peripheral Angiography ............................................................. 315
Frank Vermassen
19 Intravascular Ultrasound ........................................................... 325
Joo-Yong Hahn, Yasuhiro Honda, and Peter J. Fitzgerald
20 Fractional Flow Reserve ............................................................. 349
J.E.M. Sels, W.A.L. Tonino, and N.H.J. Pijls
21 Optical Coherence Tomography (OCT) .................................... 363
Francesco Prati, Maria Teresa Mallus, Fabrizio Imola,
and Mario Albertucci
Part V Clinical Concepts
22 Femoral and Brachial Artery Access ........................................ 379
George V. Moukarbel and Frederic S. Resnic
23 Transradial Access for Percutaneous
Coronary Interventions .............................................................. 393
Martial Hamon
24 Transpopliteal Access ................................................................. 403
Andrej Schmidt and Dierk Scheinert
25 Transpedal Access ....................................................................... 413
Andrej Schmidt and Dierk Scheinert
