Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Anticoagulants, Hematologic
Class Summary
Anticoagulants prevent recurrent or ongoing thromboembolic occlusion of the vertebrobasilar circulation.
Heparin
Heparin augments the activity of antithrombin III and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. It prevents the recurrence of a clot after spontaneous fibrinolysis. Because of the smaller-diameter arteries in the upper extremity (and, thus, the more occlusive nature of the catheters), anticoagulation is required for the procedure, and unfractionated heparin is used frequently. Many operators also administer heparin when access is obtained from the femoral artery, especially if the procedure is prolonged and several catheter exchanges are required.
Metabolic & Endocrine, Other
Class Summary
Agents in this class may prevent worsening of renal insufficiency in certain patients.
Acetylcysteine (Acetadote)
Acetylcysteine premedication in addition to hydration has been shown in one study to prevent worsening of baseline renal insufficiency. It is not indicated in all patients or in patients allergic to contrast. Acetylcysteine may scavenge oxygen-derived free radicals and improve endothelium-dependent vasodilation.
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The heart catheterization.
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Acute severe mitral regurgitation. Image courtesy of Olurotimi Badero, MD, FACP and www.tctmd.com.
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Cardiac catheterization sites.
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Femoral access. Image courtesy of Olurotimi Badero, MD, FACP and www.tctmd.com.
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Mitral stenosis tracings. Image courtesy of Olurotimi Badero, MD, FACP, and www.tctmd.com.
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Aortic stenosis tracings. Image courtesy of Olurotimi Badero, MD, FACP, and www.tctmd.com.
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Angiogram showing the left main bifurcating into the left anterior descending (LAD) and the left circumflex (LCX) arteries. Image courtesy of Olurotimi Badero, MD, FACP, and www.tctmd.com.
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Hypertrophic obstructive cardiomyopathy (HOCM) showing left ventricular outflow tract gradient at pull back. Image courtesy of Olurotimi Badero, MD, FACP, and www.tctmd.com.
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Aortogram obtained with a 6F pigtail catheter showing the ascending aorta, descending aorta, and great vessels. Image courtesy of Olurotimi Badero, MD, FACP.
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Chronic total occlusion of the right coronary artery (RCA). Image courtesy of Olurotimi Badero, MD, FACP.
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Recanalized chronic total occlusion (CTO) of the right coronary artery (RCA) after percutaneous coronary intervention. Image courtesy of Olurotimi Badero, MD, FACP.
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Judkins left 4 (JL4) catheter in place. Image courtesy of Olurotimi Badero, MD, FACP.
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Judkins right 4 (JR4) catheter in place. Image courtesy of Olurotimi Badero, MD, FACP.
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Left ventriculogram using a 6F pigtail catheter. Image courtesy of Olurotimi Badero, MD, FACP.
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Stents in the left anterior descending (LAD) and left circumflex (LCX) arteries. Image courtesy of Olurotimi Badero, MD, FACP.
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Left ventriculogram showing mid cavity obliteration in hypertrophic cardiomyopathy (HOCM). Image courtesy of Olurotimi Badero, MD, FACP.
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Angiogram showing totally occluded left main coronary artery distally. Image courtesy of Olurotimi Badero, MD, FACP.
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Angiogram showing recanalized left main coronary artery with critical trifurcation lesion involving the distal left main coronary artery. Image courtesy of Olurotimi Badero, MD, FACP.
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Image showing catheter advancing into the ascending aorta via the right radial artery in the transradial approach. Note the tortuous aorta. Image courtesy of Tak W. Kwan, MD
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Transradial cardiac angiogram showing pigtail catheter in the ascending aorta via a retro-esophageal subclavian artery (arteria lusoria). Image courtesy of Olurotimi Badero, MD, FACP.
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Tortuous brachiocephalic artery. Image courtesy of Olurotimi Badero, MD, FACP.
