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Perf Tech Final !!!!! > Alternative Approaches > Flashcards

Alternative Approaches Flashcards

1
Q

Prevalence of Heart Disease

in the U.S. (2006) ?%

A

81,100,000 (>30% of the population) has some form of heart disease

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2
Q

Most common types of Heart Disease??

A 
Hypertension (74,500,000) (systolic >140; diastolic >90)
Age 60 or older (38,100,000)
Coronary heart disease (17,600,000)
angina pectoris (10,200,000)
myocardial infarction (8,500,000)
Stroke (6,400,000)
Congestive heart failure (5,800,000)
Congenital cardiovascular defects (650,000 
–1,300,000)
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3
Q

What age has the most prevelance of CVD?

A

80+ (83/87%)

60-79 (70% ish)

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4
Q

First two most prevalent mortality causes in the US? (2006 -2010)

A
  1. Cardiovascular disease
  2. Cancer
  3. Accidents (M) Chronic lower Resp Disease (F)
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5
Q

Elimination of all forms of cardiovascular disease would increase average life span by what??
Average: 77.7 years - 2002

A

by 7 years

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6
Q

Elimination of all forms of cancer would increase the average life span by what?
Average: 77.7 years - 2002

A

by 3 years

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7
Q

Top 3 CV procedures in 2002?

A

Cath lab
angioplasty
total surgical

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8
Q

1929: Dr. Werner Forssmann

A

–First documented human cardiac catheterization

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9
Q

1941: Cournand and Richards

A

Employ cardiac catheter as diagnostic tool for the first time

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10
Q

1956: Forssmann, Cournand and Richards

A

Share the Nobel Prize

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11
Q

1958: Dr. Mason Sones

A

Developed the concept of the diagnostic coronary angiogram

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12
Q

1964: Dr. Charles Dotter

A

Introduced the concept of transluminal angioplasty

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13
Q

1967: Dr. Rene Favalo

A

Performs first saphenous vein graft surgery in Cleveland

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14
Q

1974: Andreas Gruentzigro

A

Performs first peripheral human balloon angioplasty

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15
Q

1976: Andreas Gruentzig

A

Presents results of animal studies of coronary angioplasty at the American Heart Association meeting

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16
Q

1977: Gruentzig, Myler and Hanna

A

First intraoperative human coronary balloon angioplasty (San Francisco)

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17
Q

1977: Andreas Gruentzig

A

First cath lab PTCA on awake patient (Zurich)

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18
Q

1978: Myler and Stertzer

A

First PTCA cases performed in America (San Francisco/New York)

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19
Q

1982

A

Over-the-wire coaxial balloon systems introduced –steerable guide wires developed

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20
Q

1986:

A

Coronary atherectomy devices introduced

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21
Q

1986: Puel and Sigwart

A

-First use of stents in humans reported

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22
Q

1987-1994:

A

number of interventional devices invented, perfected and approved (lasers, rotational atherectomy devices, intravascular ultrasound, stents)

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23
Q

1997:

A

Over one million angioplasties performed world-wide –most common medical intervention in world

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24
Q

2001

A

Almost two million angioplasties

performed world-wide

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25
Q

Percutaneous Transluminal Coronary Angioplasty (PTCA)

A

balloon advanced to level of blockage
–balloon inflated –plaque pushed back against vessel wall / small cracks created with the plaque (plaque fissures) / artery stretched

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26
Q

Stenting

A

balloon advanced to level of blockage –balloon inflated to deploy the stent
bare-metal versus drug-eluting stents

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27
Q

Criteria for Angioplasty? (5)

A
  • Balloon can be passed through the blockage
  • Blockage can be reached by the catheter
  • Blocked vessel is not the left main original use for one or two vessel disease –now being applied to multi-vessel cases
  • Patient is not in heart failure
  • Patient is having a heart attack (if treatment can begin within two to six hours of onset)
28
Q

Advantages of Angioplasty ?

A
  • Less invasive than bypass surgery
  • Relatively low risk
  • Relatively low cost
  • Local anesthesia versus general
  • Percutaneous incision
  • Patient able to return to normal activity shortly after procedure (most go home after 24hrs –return to normal activity within one week)
29
Q

How may stents be prevented from causing clot formation?

A

most patients placed on antiplatelet
therapy including aspirin and clopidogrel ticlopidine (Plavix /Ticlid)
must continue therapy for at least one year
–additional benefit has been shown if therapy started one to three days before procedure

30
Q

Risks/Complications of Angioplasty ? (LOTS)

A 
Bleeding from the insertion artery 
Damage to the insertion artery by the catheter
Damage to the coronary artery by the catheter
Restenosis (long term)
Sudden vessel closure
       5% of patients with PTCA only
Stents may cause clot formation
Infection
Allergic reaction to dye
Myocardial infarction
Need for emergency bypass surgery
2 to 5 percent for PTCA / 0.5% w/ stenting
Stroke
Death
31
Q

Restenosis Rates – PTCA ?

A

PTCA –10% to 40% during the first six months

32
Q

Restenosis Rates of Bare Metal Stent?

A

Bare-metal stent –30% to 50% during first six months

33
Q

Restenosis Rate of Drug Eluting Stent?

A

Drug eluting stent –7% to 15% during first six months

34
Q

Pt Restrictions Following Angioplasty (3)

A

-Refrain from lifting heavy objects, engaging in
strenuous exercise or sexual activity for at least 24 hrs
-Increased fluid intake first 24 hrs –help remove dye
-Most pts will receive some sort of anti-platelet therapy

35
Q

75% of the stent insertions follow plaque treatment with what?

A

PTCA or atherectomy

36
Q

Stent Sizing???

A
  • -stent must cover the complete length of the blockage

- -stent must be fully expanded so there are no gaps btwn the surface of the plaque and the stent

37
Q

Where is it difficult to stent?

A

bifurcations of two vessels

38
Q

When is stent covered with layer of endothelial cells?

A

Within four to six weeks the stent is covered with a thin layer

39
Q

Drug Eluting Stent is what?

A

Bare-metal stent coated with slow-to-moderate-release drug formulation that is embedded in a polymer

40
Q

What is restenosis ?

A

restenosis not a recurrence of CAD –actually bodies response to the “controlled injury” of angioplasty
restenosis characterized by growth of smooth muscle cells (i.e. scar formation)

41
Q

Boston Scientific–

A

Taxus paclitaxel- eluting stent chemotherapeutic drug

42
Q

Johnson and Johnson / Cordis =

A

Cypher sirolimus-eluting stent

immunosuppressive agent

43
Q

Medtronic & Guidant have what kind of stents??

A

drug-eluting stents in the early stages of clinical trials (2006 at the earliest)

44
Q

Drug Eluting stents have the biggest action on what type of patients?

A

Biggest impact may be on patients with diabetes

45
Q

Atherectomy

A

Currently used as adjunct to PTCA and
stent placement
Actually removed plaque material

46
Q

Atherectomy may work best in what??

A 
COMPLEX LESIONS
heavily calcified / fibrotic / undilatable lesions
ostial & branch-ostial lesions
chronic total occlusions
in-stent restenosis
47
Q

Types of Atherectomy Devices?

A

Directional
Rotational
Transluminal extraction

48
Q

Directional Atherectomy

(RPM?)

A

Percutaneous over-the-wire cutting and retrieval system
Cutting window placed toward the plaque –balloon inflated pushing plaque into cutting cup–cutter rotates at 2,000 RPM –advanced by physician

49
Q

Rotational Atherectomy?

A

Elliptical-shapes brass burr coated with 5-10 micron diamond chips
Saline flush solution infused into the plastic sheath around the drive shaft to minimize frictional heat
Burr ablates and pulverizes inelastic plaque tissue –5 micron particles eventually removed by reticuloendothelial system

50
Q

Rotational Atherectomy speed?

A

Rotates at 140-190,000 RPM

51
Q

Rotational Atherectomy burr ablates what size particles and what happens to them?

A

Burr ablates and pulverizes inelastic plaque tissue –5 micron particles eventually removed by reticuloendothelial system

52
Q

Transluminal Extraction Atherectomy

what? RPM?

A

Percutaneous over-the-wire cutting and aspiration system
Head with two stainless steel blades –turn at 750 RPM
Lactated Ringers solution flushed into area creates particulate slurry that is suctioned back through the catheter

53
Q

Transluminal Extraction Atherectomy – flushing solution?

A

Lactated Ringers solution flushed into area creates particulate slurry that is suctioned back through the catheter

54
Q

Plaque Laser Problems?

A

precise control of laser

right laser for the type of plaque

55
Q

Transluminal Angiogenesis Aka:

A

Transmyocardial revascularization

56
Q

Transluminal Angiogenesis does what?

A

Improve blood flow to an area of the heart where surgery or angioplasty may not reach
Use a CO2 laser to make 20-40 mm channels in myocardium
Outer channel closes and inner channel open to inside
the heart
May promote the growth of small new blood vessels

57
Q

Transluminal Angiogenesis option for who?

A

May be option for patients who are not candidates for

angioplasty or surgery

58
Q

Transluminal Angiogenesis done how? (incision? with?)

A

Done through L. Chest incision or midline inscision

Could be done in conjunction with angioplasty or surgery

59
Q

CABG without bypass? (2)

A

MIDCAB

OPCAB

60
Q

CABG with assisted perfusion?

A

PADCAB (perfusion assisted direct coronary artery

bypass)

61
Q

Minimal CABG with cardiopulmonary bypass access?

A

Portal-access

62
Q

OPCAB devices to hold heart/ chest open?

A

Genzyme
Guident (Ultima II)
Octopus

63
Q

Robotic type?

A

DaVinci

64
Q

Percutaneous Valves
Mitral valves?
Aortic Valves?

A

MV – E Clip

AV – Edwards, Sorin

65
Q

Aortic Valve Types? (3)

A

Edwards SAPIEN
Medtronic CoreValve
Sorin Perceval (investigational)

66
Q

Aortic Valve Insertion ways ? (4)

A

Tranfemoral
Transapical
Subclavian
Direct Aortic

Perf Tech Final !!!!! (3 decks)

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