ΕΞΕΛΙΞΗ ΤΗΣ ΔΙΑΚΕΡΚΙΔΙΚΗΣ ΠΡΟΣΠΕΛΑΣΗΣ Η ΕΛΛΗΝΙΚΗ ΕΜΠΕΙΡΙΑ Α. ΖΙΑΚΑΣ

Transcript

1 ΕΞΕΛΙΞΗ ΤΗΣ ΔΙΑΚΕΡΚΙΔΙΚΗΣ ΠΡΟΣΠΕΛΑΣΗΣ Η ΕΛΛΗΝΙΚΗ ΕΜΠΕΙΡΙΑ Α. ΖΙΑΚΑΣ

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6 ΑΥΞΗΣΗ ΤΗΣ ΧΡΗΣΗΣ ΤΗΣ ΔΙΑΚΕΡΚΙΔΙΚΗΣ ΠΡΟΣΠΕΛΑΣΗΣ

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9 ΜΕΙΟΝΕΚΤΗΜΑΤΑ Δεν µπορουν να χρησιµοποιηθουν υλικα µε µεγαλη διαµετρο

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16 WORLDWIDE UPTAKE OF RADIAL ACCESS Worldwide, an esomated 20% of procedures are per- formed by this route (29% if the US is excluded from the esomate). Although, there is considerable variaoon across Europe and Asia/Australia, these regions have the highest uptake of radial access at 30% and 40% of procedures, respecovely. The countries with the highest rates of radial access (70 80%) are found in Norway, Malaysia, and Bulgaria. Central and South America have a lower rate of radial use, esomated at 15%, and North America has a major divergence between Canada at 50% and the U.S. at less than 10%. The Middle East and Africa are the only other regions with a similarly low rate of radial access.

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32 National Cardiology data is very limited Radial approach in Greece

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36 Hellenic PCI Registry (2/ /2010) n=3441 patients: PCI Data Femoral Access 3299 (95.9%) Radial Access 109 (3.2%) IVUS 74 (2.2%) Pressure wire 67 (1.9%) IABP 7 (0.2%) Distal Protection 17 (0.5%) Thrombectomy 150 (4.3%) Vascular closure device 1135 (32.9%) ΕΚΕ

37 RADIAL APPROACH IN GREECE The radial approach has been used by Greek intervenoonal cardiologists for more than a decade and it has been gaining ground since then. However, the vast majority of procedures are soll performed using the femoral access. According to the Hellenic PCI Registry, the radial access is only used in 4.1% of all PCI procedures. 17 out of 48 cath labs gave data to the registry. Hellenic PCI Registry Femoral Access 95.9% Radial Access 4.1%

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39 RADIAL QUESTIONNAIRE We sent a quesoonnaire in each of the country s cath labs in order to get informaoon about the use of the radial approach in coronary procedures. Although we haven t received all answers yet, we have a picture of the use of the radial approach in Greece.

40 INTERVENTIONAL CARDIOLOGY IN GREECE MAP OF GREECE

41 CATH LABS IN GREECE REGION POPULATION THRACE MACEDONIA (THESSALONIKI) THESSALY EPERUS CENTRAL GREECE (ATTICA) PELOPONESE ISLANDS Aegean Ionian Crete ( ) ( ) Ionian Aegean TOTAL

42 HOSPITALS WITH CATH LAB IN GREECE ATHENS CENTRAL GREECE POPULATION (millions) 3.8/4.6 (41.0%) HOSPITALS WITH CATH LABS 31 (63%) THESSALONI KI REST OF GREECE 1.8 /2.8 (24.3%) 8 (16%) 4.0 (34.7%) 10 (20%) Ionian Aegean 1 GREECE TOTAL

43 PRIVATE VS PUBLIC PUBLIC PRIVATE ATHENS 19 (61%) 12 (39%) 2/0 4/4 1/0 THESSALO NIKI 4 (50%) 4 (50%) Ionian 0 1/0 Aegean 1/0 REST OF GREECE 8 (80%) 2 (20%) 2/0 19/12 GREECE TOTAL 31 (63%) 18 (37%) 1/2

44 ROUTINE RADIAL APPROACH- HOSPITALS 11/49 (22%) Hospitals with rouone radial operators 5/8 0/2 0/1 5/31 1/1 0/1 0/1 0/1 0/3

45 ROUTINE RADIAL APPROACH- HOSPITALS ATHENS 1 5 THESSAL ONIKI 1 5 5/8 0/2 0/1 5/31 1/1 0/1 0/1 REST OF GREECE 0 1 0/1 0/3

46 ROUTINE RADIAL APPROACH OPERATORS 6/49 (12%) Hospitals >50% with radial operators 5/8 5/31 ¾ 2/5 7/11 1/6 1/3 ½ 2/10 1/5 ½ 2/4

47 ROUTINE RADIAL APPROACH OPERATORS 258 angio operators 219 PCI operators 24 Radial operators (10.9%) 5/8 5/31 ¾ 2/5 7/11 2/3 1/6 ½ 2/10 1/5 ½ 2/4

48 ROUTINE RADIAL APPROACH HOSPITALS- PRIVATE vs PUBLIC 6 out of the 11 Hospitals with radial Operators are public 5/8 2 public 3 private 1/1 public 5/31 3 public 2 private

49 ROUTINE RADIAL APPROACH HOSPITALS- PRIVATE vs PUBLIC PUBLIC PRIVATE 6/31 (19.3%) 5/18 (27.7%) 5/8 2 public 3 private 1/1 public 5/31 3 public 2 private

50 TRANS- RADIAL PRIMARY PCI Minority of primary PCI/ s are performed trans- radially (10%), as most of STEMI paoents present to public hospitals 5/8 1/1 public 5/31 2 public 3 private 3 public 2 private

51 Training in trans- radial catheterizaoon Radial meesng 85% Training center in Greece 0 Training center abroad 15%

52 ALLEN S TEST YES 71% NO 29%

53 SHEATH TYPE Cordis 34% Arrow 49% Terumo 16%

54 SHEATH SIZE 4F 5F 6F 7F Corona ry angio 80% 20% 0 PCI 5% 80% 15%

55 SIDE PREFERENCE Right radial 85% Le{ radial 15%

56 HEPARIN- VASODILATORS Heparin Verapamil 100% 33% Nitrates 16% Verapamil +nitrates 50%

57 CATHETERS DiagnosOc Guiding LCA Judkins, Tiger, kimny EBU, XB Guiding RCA JR, AR, XB RCA

58 Reasons for transioon to femoral artery Spasm % Anatomical variaoons % Other %

59 TIME- HEMOSTASIS ANGIO Procedure Ome 12-15min PCI 40-60min Hemostasis MobilizaOon Manual/ device 0-1.5hour s device 0-24hours

60 ComplicaOons θρομβωση 3-6%, αιματωμα 5-8%, ρηξη1%radial artery occlusion Hematoma % % Other %

61 SAME- DAY DISCHARGE ANGIOGRAPH Y PCI SAME- DAY DISCHARGE 80-90% 0% TIME OF DICHARGE 4-6 hours 1 day Regarding Ome of discharge, the majority of paoents undergoing trans- radial coronary angiography is discharged the same- day of the procedure, usually within 4 to 6 hours. Same- day discharge is not used a{er trans- radial PCI at the moment, as there is no reimbursement from the NaOonal Health System.

62 PERIPHERAL INTERVENTIONS CaroOd and iliac procedures are performed only by vascular surgeons in Greece, and the use of the radial approach is rare there.

63 CONCLUSIONS The radial approach is gaining ground mainly in the private secoon GOVERMENT The public secoon directed by the government is disorganized and needs improvement as it just relies on doctors enthusiasm for new technology and paoent care, and very o{en brings difficuloes for doctors who want to establish new things

64 ΝΕΟ ΕΡΩΤΗΜΑΤΟΛΟΓΙΟ NORTHERN + CENTRAL GREECE RADIAL REGISTRY ΘΡΑΚΗ ΜΑΚΕΔΟΝΙΑ ΘΕΣΣΑΛΙΑ ΗΠΕΙΡΟΣ Ionian Aegean 1 3

65 ΕΡΩΤΗΜΑΤΟΛΟΓΙΟ Ένα ιατρό από κάθε αιμοδυναμικό εργαστήριο Αριθμό στεφ/φιων- αγγειοπλαστικών πριν 10,5,1 έτος Ποσοστό κερκιδικής προσπέλασης αντίστοιχα Αριθμό καθετηριαστών ανά εργαστήριο Καθετηριαστές εξοικειωμένοι με την κερκιδική προσπέλαση- πόσοι τη χρησιμοποιούν ως ρουτίνα

66 ΝΟΣΟΚΟΜΕΙΑ ΙΑΤΡΟΙ ΔΗΜΟΣΙΑ Π.Γ.Ν. ΑΛΕΞΑΝΔΡΟΥΠΟΛΗΣ Π.Γ.Ν. ΛΑΡΙΣΑΣ Π.Γ.Ν. ΙΩΑΝΝΙΝΩΝ ΣΤΑΚΟΣ Δ. ΔΗΜΟΠΟΥΛΟΣ Β. ΝΙΚΑΣ Δ. Ν. ΙΩΑΝΝΙΝΩΝ ΧΑΤΖΗΚΩΣΤΑ ΠΑΠΠΑ Ε. ΑΧΕΠΑ Γ.Π.Ν. ΠΑΠΑΝΙΚΟΛΑΟΥ ΖΙΑΚΑΣ Α. ΜΑΥΡΟΓΙΑΝΝΗ Α. Ν. ΠΑΠΑΓΕΩΡΓΙΟΥ ΜΠΟΜΠΟΤΗΣ Γ. 424 ΣΤΡΑΤΙΩΤΙΚΟ ΝΟΣΟΚΟΜΕΙΟ ΟΙΚΟΝΟΜΟΥ Φ. ΙΔΙΩΤΙΚΑ ΑΓ. ΛΟΥΚΑΣ ΔΙΑΒΑΛΚΑΝΙΚΟ ΙΑΤΡΙΚΟ ΚΕΝΤΡΟ ΓΕΝΙΚΗ ΚΛΙΝΙΚΗ ΘΕΣ/ΝΙΚΗΣ ΚΥΑΝΟΣ ΣΤΑΥΡΟΣ ΜΕΖΙΛΗΣ Ν. ΑΡΑΜΠΑΤΖΗΣ Α. ΑΘΑΝΑΣΙΑΔΗΣ Η. ΓΡΑΙΔΗΣ Χ.

67 ΣΤΕΦΑΝΙΟΓΡΑΦΙΕΣ

68 ΑΓΓΕΙΟΠΛΑΣΤΙΚΕΣ

69 ΚΑΘΕΤΗΡΙΑΣΤΕΣ

70 ΔΗΜΟΣΙΑ vs ΙΔΙΩΤΙΚΑ ΣΤΕΦΑΝΙΟΓΡΑΦΙΕΣ

71 ΔΗΜΟΣΙΑ vs ΙΔΙΩΤΙΚΑ PCI

72 ΔΗΜΟΣΙΑ vs ΙΔΙΩΤΙΚΑ ΚΑΘΕΤΗΡΙΑΣΤΕΣ

73 ΣΥΜΠΕΡΑΣΜΑΤΑ Η διακερκιδική προσπέλαση εξελίχθηκε πολύ και χρησιμοποιείται πλέον ως προσπέλαση επιλογής σε μεγάλο ποσοστό διεθνώς. Τα πανελλαδικά στοιχεία σχετικά με τη χρήση της διακερκιδικής προσπέλασης είναι ελάχιστα. Η χρήση της διακερκιδικής προσπέλασης αυξήθηκε σημαντικά τουλάχιστον στη βόρειο και κεντρική Ελλάδα, πιθανότατα και σε όλη την Ελλάδα. Η διείσδυση της κερκιδικής είναι σαφώς μεγαλύτερη στον ιδιωτικό τομέα. Χρειαζόμαστε σίγουρα μια νέα πανελλαδική καταγραφή.