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Chapter 20: Cardiac Catheterization, Cardiac Angiography, and Coronary Blood Flow and Pressure Measurements

The radial artery approach is associated with reduced bleeding complications and increased patient satisfaction. Which of the following factors is not an additional reason to favor the right radial artery approach over the femoral artery approach?

A. Easy access

B. Direct cannulation of left internal mammary artery grafts in patients with prior coronary bypass

C. Most secure hemostasis in fully anticoagulated patients

D. Radial artery occlusion is generally well tolerated

E. Superficial location

The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 20) The radial approach is favored for several additional reasons: (1) The radial artery is easily accessible and is not located near significant veins or nerves; (2) the superficial artery location permits rapid and secure compression band hemostasis; (3) the radial artery access provides the most secure hemostasis in fully anticoagulated patients; (4) because of the collateral flow to the hand through the ulnar artery, the rare case of radial artery occlusion is generally well tolerated; and (5) patient comfort is enhanced by the ability to sit up and walk immediately after the procedure. However, the right radial approach is not directly amenable to cannulation of the left internal mammary artery graft for patients with prior coronary bypass.

A 68-year-old man with prior reactions to contrast media, history of type 2 diabetes, chronic kidney disease, and left ventricular systolic dysfunction presented to the emergency department with a 2-hour history of retrosternal chest pain. ECG on arrival showed ST-elevation in interior leads, and the patient was emergently taken to the cardiac catheterization laboratory for primary PCI. Which of the following radiographic contrast agents will be preferred in this case?

A. Iodixanol

B. Diatrizoate

C. Iothalamate

D. Metrizoate

E. Iopamidol

The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 20) The advantages of the nonionic, low-osmolar agents include less hemodynamic loading, less patient discomfort, less depression of myocardial function and blood pressure, and fewer anaphylactoid reactions. Currently, nonionic, low-osmolar agents are routine for nearly all patients, and they are especially helpful in patients with poor LV function, renal disease, diabetes, or prior reactions to contrast media. Iodixanol is a nonionic, iso-osmolar dimer that is parti­cularly well tolerated and used selectively in patients with peripheral arterial procedures and prior contrast reactions. Diatrizoate, iothalamate, and metrizoate (options B, C, and D) are all high-osmolar ionic contrast agents, whereas iopamidol ...

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