The Cardiovascular Medicine Catheterization Laboratories, directed by Giorgio Gimelli, MD, perform more than 3,600 procedures annually, including more than 1,800 diagnostic cardiac catheterizations. University of Wisconsin Hospital and Clinics' facilities include two Phillips biplane coronary laboratory, a Phillips single-plane coronary laboratories, a Phillips biplane lab dedicated to electrophysiologic studies, and a new large bore-equipped lab equipped with digital subtraction technology for peripheral vascular diagnostic and interventional procedures. Two additional laboratories at Meriter Hospital and one at Middleton VA Hospital complete the program.
A Camtronics 'cine-less' digital image management system servesall labs. Imaging modalities also include on-line quantitative angiography, intravascular ultrasound and Doppler flow-wire assessment of coronary artery stenoses. Approximately 20 percentof all coronary artery diagnostic and interventional procedures arenow performed via transradial artery (wrist) access, an approach offering greater patient comfort and earlier ambulation than conventional femoral artery access. Outpatient coronary diagnosticand interventional procedures are performed in conjunction withthe recently constructed adjacent Procedure Center, which feature comfortable private patient recovery rooms as well as waiting areas andconference rooms for patients and their families.
The interventional program performs more than 1,100 coronary interventions a year, including 800 at the University catheterization laboratories, more than 100 coronary interventions annually at the adjacent William S. Middleton Memorial Veterans Hospital, and over 200 per year at Meriter. In addition tocoronary balloon angioplasty and stenting, the program offersadvanced coronary revascularization techniques, including rotational, directional and extractional atherectomy for complex lesionanatomy. The program draws patients from a four state area (Wisconsin, Iowa, Illinois and Michigan) for high-risk and/or complex percutaneous coronary revascularization.
Twenty-four hour emergency call is provided to support primary angioplasty for acute myocardial infarction at both the University of Wisconsin Hospital and Clinics and Meriter Hospitals. Coronary and peripheral brachytherapy (intracoronary radiation therapy) is currently available for patients with recurrent narrowing in previously implanted coronary stents (in-stent restenosis), as are drug eluting stents.
A rapidly growing peripheral vascular program offers state-of-the-art diagnostic digital subtraction angiography as well as specialized carbon dioxide (CO2) and gadolinium angiography for patients with impaired renal function. Interventional procedures include carotid, subclavian, renal, iliac, femoral and popliteal artery angioplasty, stenting, and brachytherapy. The program collaborates closely with vascularsurgeons trained in endovascular techniques, and percutaneously deployed stent-grafts are implanted to treat anatomically suitable abdominal aortic aneurysms.
Clinical research in the catheterization laboratories is supported by a dedicated research nurse and a clinical database. Recent multicenter studies conducted in our laboratory include trials of coronary brachytherapy to prevent or treat restenosis following coronary interventions, oral and intravenous glycoprotein IIb/IIIa inhibitors and other anticoagulants to reduce coronary intervention complications, and oral growth factor inhibitors to prevent restenosis.The laboratory has participated in the intravascular ultrasound substudies of many of these trials in addition to long-term intravascular ultrasound studies of post-cardiac transplant coronary arteriopathy.
Basic research in interventional cardiology is performed in a dedicated, single-plane Phillips animal catheterization laboratory. Ongoing, extramurally-funded animal research includes studies of cardiac gene transfer and neoangiogenesis in chronic coronary ischemiamodels, restenosis following implantation of radioactive coronarystents, magnetic resonance measurements of coronary blood flow and low-radiation exposure scanning beam digital cardiac imaging.
Educational opportunities in the catheterization laboratory include monthly rotations in diagnostic coronary catheterization for cardiovascular medicine fellows as well as a funded accredited fourth year interventional cardiology fellowship. A multiple-lecture didactic curriculum is presented annually to the cardiology fellows on topics related to coronary artery and peripheral vascular disease. Interesting cases are discussed at a weekly catheterization and hemodynamics conference, and fellows are encouraged to attend a weekly multidisciplinary vascularmedicine conference.
Cardiac Catheterization Laboratory Faculty