How high is the stroke incidence with ‘blind’ catheterization of the VSM graft? I couldn’t find any data on this. Thank you for the insightful lectures.
Great question. Recently, a great trial was presented at TCT (BYPASS-CTCA) They randomized pts with prior CABG to CTA prior to angiography (+/-PCI) vs no CTA. CTA allowed dramatic reduction of procedural time and contrast, as well as periprocedural MI, and more radial access (as it allows you to know how many grafts/where/which grafts are patent). Stroke risk was the same (0.3%-0.87%) (that is much higher than non-CABG angiography)
Hi Dr. Hanna, thanks for the great video. I’m not familiar with the BC catheter that you mentioned to engage ambulated LIMA takeoff. Is it the same as Cordis VB-1 catheter? Can you please share a link for it?
BC (Bartorelli Cozzi), also by Cordis, is different from VB-1. Both have sharper angulations than IM catheter, but the curve on VB-1 is wider than BC. BC was designed for transradial cannulation of IM (from right or left radial), while VB-1 was designed for difficult IM cannulation, eg tortuous subclavian, mainly transfemorally. But I think VB-1 may also work transradially. This is a link to BC: www.cardinalhealth.kr/content/dam/corp/products/professional-products/ous-patient-recovery/documents/cordis-radial_solutions_brochure.pdf
*Regarding clopidogrel in conservatively managed SCAD, there is very limited data, and some Italian registry data questions the benefit (EHJ 2021). According to an AHA review in 2018, it is commonly used for anywhere between 1 to 12 months (I favor ~1 month). Decision is individualized: a young woman with heavy menstruation may not tolerate it at all. *The main difference of SCAD 3 is that it cannot be diagnosed angiographically, unlike SCAD 1 and most SCAD 2. SCAD 3 requires IVUS/OCT for diagnosis, while the IVUS/OCT is frequently omitted in SCAD1/2. SCAD 3 is mainly diagnosed in the setting of IVUS/OCT for MINOA (MI with nonobstructed coronaries). Management is the same, mainly conservative.
