IVUS-Guided Bifurcation PCI with HDi IVUS – Radcliffe Cardiology

Clinical data shows that routine use of intravascular imaging improves clinical outcomes of patients undergoing PCI. It delivers critical anatomical information pre-and post-stenting. Thereby, HD-IVUS enables “high-precision” interventional therapy. especially for complex PCI procedural guidance. In this webinar, you can learn about the advantages of the ACIST HDi IVUS System, the potential limits and possible prognostic impact of angiography in displaying crucial anatomical patient information, the advantages of pre- and post-PCI IVUS measurements, and optimal MSA after PCI. You may also better understand the principles of imaging and HD intravascular ultrasound’s (IVUS) role in lesion assessment and stent placement and the importance of accurate lesion assessment and optimal stent placement in achieving successful outcomes for patients undergoing PCI procedures. Get to know new features of HDi.

Resolving Proximal Cap ambiguity with #IVUS

During the MLCTO meeting in 2023, Dr Ram Vijayaraghavan from Scarborough Health Network in Toronto, Canada, shared a case presentation in which he explains how the ACIST HDi IVUS can assist physicians in identifying the proximal cap during CTO PCI procedures. He emphasized that resolving proximal cap ambiguity with IVUS is among the initial consideration physicians should prioritize when planning a procedure.

HDi Instruction Videos Playlist

[Transcript]

To power on the system, press the power button on the side of the system console.

A system self-test and startup sequence begins.

When the power up sequence completes, system login appears.

Enter the system login password.

A default system login password of 1, 2, 3, 4 is assigned to every console.

After installation a custom password will be created.

While a new system login password can be created, anytime doing so causes all study data currently stored on the system to be permanently deleted.

After entering the correct system login password the acquire screen will appear on the touch screen.

The optional lts is connected verifying the lts indicator is shown in white on the touch screen.

To start recording while using the pim and lts, press pull back on the console or press start button on the lts.

A green light on the pullback button illuminates when pullback is activated.

When pullback starts imaging and recording automatically starts if not previously started and vertical green reference line appears on the longitudinal image to indicate one millimeter intervals.

To stop pullback imaging and recording simultaneously simply press the image button on the console or the pim.

The field of view can be adjusted using the zoom function.

Adjusting image depth optimizes the display of tissue structures in varying sized arteries.

Press the zoom button to scroll through the ten millimeter, eight millimeter and six millimeter diameter field of view.

The diameter and graticule field of view are displayed on the lower left of the touch screen when imaging.

For example at the default setting of 10 millimeters there are 10 horizontal and 10 vertical graticules each representing one millimeter field of view.

Operating Frequency

The hdi system operates at either standard definition 40 megahertz or high definition 60 megahertz.

Press the sixty megahertz button to select the desired image definition.

When not illuminated it indicates the system is using the forty megahertz frequency setting.

The setting is also displayed in the lower left information block.

As a quick note the operating frequency can only be changed when recording is stopped.

Turn on the HDi® System console if it isn’t already powered on.

Using two operator sterile technique remove the Kodama® Catheter and sterile sleeve from the package.

The sterile operator starts by unfolding the sterile sleeve, making certain the sleeve attachment is on top of the fold out section.

If the lts is to be used, the non-sterile person inserts the pin into the lts carriage and slide the pim and lts carriage to its fully retracted position and lock it into place by pressing the manual button on the lts.

The manual indicator light should go out.

The sterile operator then inserts their hands into the folds of the sterile sleeve and present the open end to the non-sterile operator.

After the non-sterile operator inserts the pim and lts into the sterile sleeve opening the sterile operator receives the pim and lts assembly by grasping it through the sterile sleeve.

The non-sterile operator grasps the proximal end of the sterile sleeve and pulls it over the pim and lts cables.

Care must be taken to prevent the non-sterile cables from contacting the sterile field.

Placing the pim and lts assembly on a flat even surface, the sterile operator secures the sterile sleeve to the pin by fully seating the three pins on the sleeve into the nose of the pin.

The sterile operator starts prepping the Kodama catheter by disconnecting the 10 milliliter syringe and filling it with sterile anticoagulant saline.

Clear all the air bubbles and flush the dispenser coil using the coils lure port.

Filling the coil activates the hydrophilic coating.

Fefill the 10 milliliter syringe with sterile anticoagulant saline.

Clear all the air bubbles and reconnect the syringe to the catheter stop.

rotate the stopcock on the extension set and fill the three milliliter syringe from the 10 milliliter syringe.

The 10 milliliter syringe is used as a reservoir for refilling the 3 milliliter syringe.

Rotate the stopcock so the 3 milliliter syringe is set to introduce anticoagulant saline into the catheter.

The sterile operator may disconnect the proximal end of the kodama catheter from the hoop and connect the catheter hub to the pim nose through the sterile sleeve

attachment.

A discernable click indicates the catheter hub is fully seated on the pin.

Confirm the catheter indicator on the touchscreen turns from orange to white.

Slide the sterile sleeve so the anchor window is over the groove on the front of the lts.

Leaving sufficient folds of the sleeve material between the front of the lts and the pim nose allows free movement of the pim and lts assembly.

While pressing the orange button on the side of the lts, slide the telescope anchor into the lts groove.

Ensure the orange hook is fully closed and centered on the telescope anchor.

Confirm indicator on the touch screen turns from orange to white.

Flush out the kodama catheter twice using the full three milliliter syringe.

Press the manual button to release the pin slide the pin and lts carriage all the way forward.

Press the manual button again to lock the pin into the forward position.

 

Note: See full resource above for complete citations and references.

 

HDI Advanced IVUS Webinar Series

Join Dr. Joost Daeman, an Interventional Cardiologist at Erasmus University Medical Center, Rotterdam, the Netherlands, and Jurgen Ligthart, a Percutaneous Imaging Specialist at Erasmus, for a four-episode webinar series. In the first webinar, explore the fundamentals of intravascular ultrasound (IVUS) image interpretation and procedural guidance. Watch a step-by-step demonstration of an IVUS-guided PCI procedure featuring the ACIST HDi® HD IVUS System and Kodama® HD IVUS Catheter. Discover the benefits of the HDi® System throughout the entire patient care process. This spans from pre-procedure planning to real-time decision-making and post-procedural assessment. Expand your knowledge and optimize your approach by immersing yourself in this engaging webinar series.

 

“In conclusion, clearly in the last 20-30 years a lot of improvements in IVUS technology, which at least to my experience made the IVUS more accessible to people who do not use it on a daily basis, but still want to get acquainted or get familiar with intravascular imaging. So adjudicating the different types of plaque, dissections, and all the things you might encounter really became, I would almost say easier with the higher frequency technologies.” – Dr. Daeman

 

Note: See full resource above for complete citations and references.

HD IVUS Guidance in PCI as the standard of Care, Profs Hammerstingl and Volz

Clinical data shows that routine use of intravascular imaging, such as IVUS, improves clinical outcomes of patients undergoing PCI. It delivers critical anatomical information pre- and post-stenting. Thereby, HD-IVUS enables “high-precision” interventional therapy. In this video, Prof Christoph Hammerstingl and Dr. Alexander Völz from Eduardus Hospital Cologne (Germany) talk about why intravascular imaging should become the standard of care, not just for complex PCI procedural guidance.

DAIC Webinar: Improving Patient Outcomes and Reducing Contrast Utilization in the Cath Lab

Click here to watch the video.

This webinar features Dr. Khuddus, an Interventional Cardiologist at HCA Florida North Florida North Florida Hospital and the Cardiac and Vascular Institute in Gainesville, Florida, and Dr. Doshi, an Interventional Cardiologist at Massachusetts General Hospital in Boston, Massachusetts. Dr. Khuddus and Dr. Doshi walk through the use of the ACIST CVi™ Contrast Delivery System and the ACIST HDi® HD IVUS System to manage contrast usage and ultimately improve patient outcomes. To do this ACIST’s technologies strive to reduce contrast usage, improve Acute Kidney Injury (AKI) rates, and deliver optimized patient outcomes. Watch the video above to learn about the benefits of implementing a variable rate contrast delivery system in the cath lab, the clinical benefits of HD IVUS utilization and how to implement standardized workflow for effective use, and how HD IVUS and physiological testing can be used to improve patient outcomes and reduce contrast utilization.

 

“The injector does four things. One, it makes the procedure much easier for the operator. Two, it can help reduce procedure time. Three, it can definitively help decrease contrast usage. Four, it has built in safety mechanisms to ensure that nothing is injected that we don’t want injected. The device as a whole really makes any procedure safer, more efficacious, and faster” – Dr. Doshi

 

Note: See full resource above for complete citations and references.

 

Zero-Contrast PCI Using HD IVUS and Physiological Guidance

 

Click the image above, or click here to access the video.

In partnership with Radcliffe Cardiology, ACIST recorded a case discussion with Dr. Ali, an Interventional Cardiologist at St. Francis Hospital & Health Center, Dr. Daemen, an Interventional Cardiologist at the Erasmus University Medical Center, Rotterdam, the Netherlands, and Dr. Jeremias, Associate Director, Cardiac Cath Lab at St. Francis Hospital and Heart Center, at EuroPCR 2023. The case covers the use of various ACIST products and the value they bring to the cath lab. These include ACIST CVi™ Contrast Delivery System, ACIST HDi® HD IVUS System and Kodama® HD IVUS Catheter, and ACIST RXi® Rapid Exchange FFR System along with Navvus®II Rapid Exchange MicroCatheter. CVi® is known for its ability to manage contrast dose and waste, but this case discussion also incorporates the roles imaging and physiology play in the larger contrast management conversation. Overall, its an informative video exploring the use of ACIST’s advanced technologies and best practices in coronary interventions. Watch the video above to hear more.

 

Note: See full resource above for complete citations and references.

Post-PCI FFR Values and Post-PCI IVUS Findings – 2-Year FFR REACT Results

This study examines the influence of post-PCI intravascular ultrasound (IVUS) evaluation on operator strategy. The objective is to evaluate the effects of additional optimization in patients with low post-PCI FFR values. The trial indicates that performing additional optimization techniques improves post-PCI FFR in patients with FFR < 0.90. The FFR REACT trial utilized IVUS guidance to optimize PCI in patients with low post-PCI FFR values.

 

Background: Additional optimization in patients with low post-PCI FFR significantly improves post-PCI FFR values. In the FFR REACT trial, we used IVUS to guide PCI optimization in patients with post-PCI FFR < 0.90.

Aims: To assess the impact of post-PCI FFR pullback data and post-PCI IVUS findings on operator strategy.

IVUS evaluation changed treatment strategy in 53.1% of vessels (76/143, p<0.001)

 

Note: See full resource above for complete citations and references.
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