Table Of Content3
RD EDITION
THE
INTERVENTIONAL
CARDIAC
CATHETERIZATION
HANDBOOK
Edited by
Morton J. Kern, MD, FSCAI, FACC, FAHA
Chief
Department of Cardiology
Long Beach Veterans Administration Health Care System
Long Beach, California;
Professor of Medicine and Associate Chief, Cardiology
University of California, Irvine
Orange, California
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
THE INTERVENTIONAL CARDIAC
CATHETERIZATION HANDBOOK THIRD EDITION ISBN: 978-0-323-08057-6
Copyright © 2013 by Saunders, an imprint of Elsevier Inc.
Copyright © 2004, 1996 by Elsevier Inc.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by
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or formula, the method and duration of administration, and contraindications. It is the
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individual patient, and to take all appropriate safety precautions.
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Library of Congress Cataloging-in-Publication Data
Kern, Morton J.
The interventional cardiac catheterization handbook / Morton J. Kern – 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-08057-6 (pbk. : alk. paper)
I. Title.
[DNLM: 1. Heart Catheterization--methods--Handbooks. WG 39]
LC classification not assigned
616.1'20754--dc23
2012012301
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Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my friends who work in the cath labs around the
world - this one is for you.
and
To Margaret and Anna Rose, for putting all dear things
in proper perspective. Thank you.
iii
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Contributors
Wail Al Kashkari, MD
Interventional Fellow
Rush Center for Congenital and Structural Heart Disease
Rush University Medical Center
Chicago, Illinois
Ryan Berg, MD, FACC
Assistant Professor of Medicine
Associate Program Director
Cardiology
UCSF Fresno
Fresno, California
John A. Bittl, MD
Interventional Cardiologist
Munroe Heart and Vascular Institute
Munroe Regional Medical Center
Ocala, Florida
Christine Cabiling, BS
Senior Product Manager
Marketing
Edwards Lifesciences
Irvine, California
Qi Ling Cao, MD
Research Faculty
Rush Center for Congenital and Structural Heart Disease
Rush University Medical Center
Chicago, Illinois
Ahmad Edris, MD
Fellow
Cardiovascular Disease
Department of Cardiology
University of California
Irvine School of Medicine
Irvine, California
Ted Feldman, MD, FESC, FACC, FSCAI
Professor of Medicine
Northwestern University
Feinberg School of Medicine
Chicago, Illinois;
Director
Cardiac Catheterization Laboratory
Evanston Hospital
Evanston, Illinois
v
vi Contributors
Connie N. Hess, MD
Fellow
Cardiology
Division of Cardiology
Duke University Medical Center
Durham, North Carolina
Ziyad M. Hijazi, MD, MPH, FSCAI, FACC, FAAP
Professor of Pediatrics and Internal Medicine
James A. Hunter, MD, University Chair;
Director
Rush Center for Congenital and Structural Heart Disease
Rush University Medical Center
Chicago, Illinois
John M. Hodgson, MD
Department of Cardiology
Geisinger Health System
Wilkes-Barre, Pennsylvania
Morton J. Kern, MD, FSCAI, FACC, FAHA
Chief
Department of Cardiology
Long Beach Veterans Administration Health Care System
Long Beach, California;
Professor of Medicine and Associate Chief, Cardiology
University of California, Irvine
Orange, California
Michael S. Kim, MD
University of Washington School of Medicine
Seattle, Washington
Andrew J. Klein, MD
Associate Professor of Medicine
Cardiology
John Cochran VA Medical Center
Saint Louis University School of Medicine
St. Louis, Missouri
Mitchell W. Krucoff, MD, FACC, FAHA, FSCAI
Professor
Medicine/Cardiology
Duke University Medical Center;
Director
Cardiovascular Devices Unit
Duke Clinical Research Institute
Durham, North Carolina
Michael S. Lee, MD, FACC, FSCAI
Assistant Professor
Medicine
UCLA Medical Center
Los Angeles, California
Michael J. Lim, MD, FACC, FSCAI
Director
Division of Cardiology and J. Gerard Mudd
Cardiac Catheterization Laboratory
Department of Internal Medicine
Saint Louis University
St. Louis, Missouri
Contributors vii
Mohammad Marashdeh, MD
Interventional Cardiologist
Saint Clair Regional Medical Center
Morehead, Kentucky
Igor F. Palacios, MD
Director of Interventional Cardiology and Structural
Heart Disease Interventions
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
Charles M. Parise, MD
Chief Fellow
Division of Cardiology
University of California, Irvine
Orange, California
Pranav M. Patel, MD
Interim Chief and Associate Professor
Cardiology;
Director
Cardiac Catheterization Laboratory
Cardiology
University of California, Irvine
Orange, California
Sunil V. Rao, MD
Associate Professor of Medicine
Cardiology
Duke University Medical Center
Durham, North Carolina;
Director
Cardiac Catheterization Laboratories
Durham VA Medical Center
Durham, North Carolina
Jonathan A. Rapp, MD
Assisting Staff
Department of Cardiology
Ochsner Medical Center
New Orleans, Louisiana
Michael H. Salinger, MD
Assistant Clinical Professor of Medicine
Section of Cardiology
University of Chicago School of Medicine
Chicago, Illinois;
Director
Interventional Cardiology
NorthShore University HealthSystem
Evanston, Illinois
viii Contributors
Arnold H. Seto, MD, MPA
Assistant Clinical Professor
Cardiology
University of California, Irvine
Orange, California;
Assistant Clinical Professor
Cardiology
Long Beach VA Medical Center
Long Beach, California
Nauman Siddiqi, MD
Cardiology Fellow
University of California, Irvine
Orange, California
Kimberly A. Skelding, MD, FACC, FAHA, FSCAI
Associate
Interventional Cardiology, Geisinger Medical Center;
Director of Cardiovascular Genomics and Cardiovascular Research
Geisinger Center for Health Research
Danville, Pennsylvania
Paul Sorajja, MD
Associate Professor of Medicine
Cardiovascular Diseases
Mayo Clinic
Rochester, Minnesota
William M. Suh, MD
Assistant Clinical Professor
Department of Medicine
Ronald Reagan UCLA Medical Center
Los Angeles, California
Barry F. Uretsky, MD
Clinical Professor of Medicine
Internal Medicine
University of Arkansas for Medical Sciences
Little Rock, Arkansas;
Director
Interventional Cardiology
Cardiology
Central Arkansas Veterans Health System
Little Rock, Arkansas
Christopher J. White, MD, FSCAI, FACC, FAHA, FESC
Professor of Medicine and System Chair for Cardiovascular Diseases
The Ochsner Clinical School
University of Queensland;
Medical Director
John Ochsner Heart and Vascular Institute
Ochsner Medical Center
New Orleans, Louisiana
Todd K. Zynda, DO
Fellow
Cardiovascular Disease
University of California, Irvine
Orange, California
Preface
The discipline of interventional cardiology, an American Board of
Internal Medicine–certified subspecialty since 1999, requires an under-
standing and application of extensive specialty information and skills.
Success in interventional cardiology requires the mastery of complex
cognitive information coupled with the in-lab, minute-by-minute appli-
cation of techniques used to implant coronary and peripheral stents,
repair vascular injury and structural heart defects, and manage critically
ill patients, at times simultaneously. The interventional physician and his
or her team should have a complete understanding of the indications
and practice guidelines for percutaneous coronary intervention (PCI),
coronary bypass graft surgery, and medical therapy for coronary, periph-
eral arterial, and structural heart d isease. Specifically the physician and
team should know:
• The chance of a successful procedure
• The benefit/risk to the patient if the procedure is successful/
unsuccessful
• The occurrence and management of various complications
These facts must also be integrated into judgments for a specific
patient given a large variety of factors related to the comorbidities and
underlying medical cardiac and noncardiac conditions.
In this third edition of The Interventional Cardiac Catheterization
Handbook, we have tried to provide the critical information to those
beginning their journey into interventional cardiology. Of course this
material is an extension of techniques and methods described for diag-
nostic catheterization and specially related techniques in The Cardiac
Catheterization Handbook, fifth edition. Excellence in intervention
begins with excellence in diagnostic catheterization. The ICCH third
edition is a handbook and by design cannot include every aspect of the
universe of interventional cardiology. Such detail is provided in larger
reference textbooks in the field.
The ICCH third edition is new in several ways. Beyond a redesigned
format with full color images, making the reading and diagrams eas-
ier and more instructional, the contents have been brought as up to
date as possible given the nature of printed books. Many of the basic
chapters discuss what PCI does and how to achieve best access, and
angiographic images now reflect the modern approach with both third-
generation drug-eluting stents as the principal tool to open arteries
and radial access highlighted to emphasize the increased safety of this
method. Angiographic views for intervention, use of different contrast
media, and identification of patients at high risk are fundamental read-
ing for all students and physicians meeting the minimum knowledge
requirements.
In contrast to the prior editions, more focused and specific chap-
ters now emphasize the unique nature of several well-recognized and
well-studied angiographic subsets undergoing complex PCI such as
bifurcation lesions, left main stenosis, chronic total occlusions, saphe-
nous vein graft interventions, complications, and peripheral vascular
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