Basics Of Coronary Interventions Flashcards
What are the two types of PCI balloon catheters?
Over-the-wire
Monorail/rapid-exchange catheters
What is the major advantage of OTW balloon/stent catheters during PCI?
A) They allow for easier insertion of stents
B) They maintain distal artery access even after the guidewire is removed
C) They are smaller in diameter than rapid-exchange catheters
D) They do not require guidewire exchanges
B) They maintain distal artery access even after the guidewire is removed
How many lumens does an OTW balloon/stent catheter typically have?
A) One lumen
B) Two lumens
C) Three lumens
D) Four lumens
B) Two lumens
What is the length of an OTW balloon/stent catheter?
A) 100–120 cm
B) 130–140 cm
C) 145–155 cm
D) 300 cm
C) 145–155 cm
What is the purpose of the second lumen in an OTW balloon/stent catheter?
A) To administer medications such as nitrates or thrombolytics
B) To assist in guiding the catheter into the coronary artery
C) To monitor coronary pressure
D) To inject contrast into the coronary arteries
A) To administer medications such as nitrates or thrombolytics
What is required to exchange OTW catheters?
A) The balloon must be inflated
B) The balloon is advanced over the wire to a distal position, and the guidewire is exchanged
C) The catheter must be removed and replaced entirely
D) A longer balloon catheter is used in place of the original
B) The balloon is advanced over the wire to a distal position, and the guidewire is exchanged
Which guidewire length is typically preferred for exchanging OTW catheters?
A) 145 cm
B) 300 cm
C) 120 cm
D) 200 cm
B) 300 cm
What facilitates the exchange of OTW catheters, especially when using a short guidewire?
A) Balloon inflation
B) Guidewire extension devices or magnets
C) Catheter inflation
D) Additional guide catheters
B) Guidewire extension devices or magnets
What is the limitation of OTW systems compared to rapid-exchange (monorail) catheters?
A) They are more difficult to use with larger guidewires
B) They require longer guidewire exchanges and have a larger diameter
C) They cannot accommodate multiple guidewires
D) They do not maintain distal artery access
B) They require longer guidewire exchanges and have a larger diameter
The OTW catheter system tracks better because:
A) It has a longer balloon length with a guidewire in the lumen
B) It is smaller in diameter than other catheters
C) It requires no guidewire exchanges
D) It uses a non-coaxial design for greater flexibility
A) It has a longer balloon length with a guidewire in the lumen
Why might additional personnel be required during the exchange of OTW catheters?
A) To assist with catheter insertion
B) To help with long guidewire catheter exchanges
C) To perform pressure monitoring during the procedure
D) To inject contrast media into the artery
B) To help with long guidewire catheter exchanges
What is the main advantage of rapid-exchange (monorail) catheters compared to OTW catheters?
A) They allow for faster balloon inflation
B) They can be exchanged by a single operator
C) They have a larger diameter
D) They require multiple guidewires for exchange
B) They can be exchanged by a single operator
How many lumens do rapid-exchange (monorail) catheters typically have?
A) One lumen
B) Two lumens
C) Three lumens
D) Four lumens
B) Two lumens
What is the length of the distal catheter shaft in a rapid-exchange catheter that holds two lumens?
A) 10–20 cm
B) 30–40 cm
C) 50–60 cm
D) 70–80 cm
B) 30–40 cm
Which design feature allows rapid-exchange (monorail) catheters to have a smaller diameter compared to OTW balloon catheters?
A) The balloon is larger in diameter
B) Only a limited portion of the catheter requires two lumens
C) The catheter is shorter in length
D) The catheter is more flexible
B) Only a limited portion of the catheter requires two lumens
One of the limitations of rapid-exchange (monorail) catheters is:
A) The need for multiple operators during catheter exchange
B) They are more difficult to manipulate and assemble
C) They are larger in diameter than OTW catheters
D) They require long guidewire exchanges
B) They are more difficult to manipulate and assemble
What can happen if the monorail balloon is advanced beyond the distal end of the guidewire?
A) The balloon may not inflate
B) The balloon may cause excessive pressure on the coronary vessel
C) The guidewire may come out of its short lumen, requiring catheter withdrawal and reassembly
D) The balloon may rupture
C) The guidewire may come out of its short lumen, requiring catheter withdrawal and reassembly
What is a potential complication when advancing a monorail balloon catheter that requires substantial force?
A) The catheter might collapse
B) A loop of guidewire may form outside the guide catheter in the aorta
C) The catheter may become clogged with thrombus
D) The balloon may get stuck in the coronary artery
B) A loop of guidewire may form outside the guide catheter in the aorta
Why might a loop of guidewire be nearly invisible when advancing the monorail balloon catheter?
A) The loop is formed inside the coronary artery
B) The loop is formed outside the guide catheter in the aorta
C) The loop is formed in the guiding catheter
D) The loop is formed inside the balloon catheter
B) The loop is formed outside the guide catheter in the aorta
Rapid-exchange catheters are particularly useful in PCI because they:
A) Are easier to exchange than OTW catheters and require no guidewire
B) Allow the operator to exchange catheters with one hand
C) Are used for larger lesions only
D) Require no guide catheter for insertion
B) Allow the operator to exchange catheters with one hand
When using a monorail catheter, what is the risk if the guidewire is manipulated improperly during balloon advancement?
A) The balloon may rupture
B) The catheter may become disconnected
C) The guidewire may exit its short lumen, causing the need to withdraw the catheter and reassemble it
D) The catheter may cause a myocardial infarction
C) The guidewire may exit its short lumen, causing the need to withdraw the catheter and reassemble it
What is the main differentiating feature among balloon catheters?
A) Stiffness
B) Strength
C) Compliance
D) Length
C) Compliance
A moderately compliant balloon will increase in size by approximately what percentage above nominal pressure?
A) 5%–10%
B) 10%–20%
C) 20%–30%
D) 30%–40%
B) 10%–20%
What is the main advantage of non-compliant (NC) balloons compared to compliant balloons?
A) They expand much more than compliant balloons
B) They remain close to their rated diameter even when inflated several atmospheres above nominal pressure
C) They are more flexible
D) They have a larger balloon diameter
B) They remain close to their rated diameter even when inflated several atmospheres above nominal pressure
Overinflating a compliant balloon can result in:
A) A smaller balloon size
B) Increased pressure at the balloon’s ends
C) Balloon oversizing and possibly causing a dissection
D) Faster stent deployment
C) Balloon oversizing and possibly causing a dissection
What is typically performed after stent deployment to ensure proper stent expansion?
A) Low-pressure inflation
B) No inflation is required
C) High-pressure inflation with NC balloons
D) Balloon deflation
C) High-pressure inflation with NC balloons
According to Laplace’s law, what happens when inflating a balloon above the rated burst pressure?
A) Wall stress decreases with radius
B) Wall stress increases with radius
C) Balloon expansion stops
D) Vessel diameter decreases
B) Wall stress increases with radius
What should an operator consider when inflating a balloon above the rated burst pressure?
A) No special considerations are needed
B) Limiting the number and duration of inflations
C) Increasing the balloon size during each inflation
D) Stopping the procedure immediately
B) Limiting the number and duration of inflations
What happens to balloon diameters as pressure increases?
A) They decrease in size
B) They remain the same
C) They increase in size
D) They oscillate between sizes
C) They increase in size
Even non-compliant (NC) balloons will grow by what percentage over nominal when inflated with high pressure?
A) <5%
B) <10%
C) 10%–20%
D) 20%–30%
B) <10%
Which of the following is a limitation of angioplasty balloon catheters?
A) They are unable to expand
B) They cause significant vessel dilation at low pressures
C) Overinflation, especially near the balloon ends, can lead to artery trauma
D) They are too rigid for use in coronary arteries
C) Overinflation, especially near the balloon ends, can lead to artery trauma
When selecting a balloon size for PCI, it is generally recommended to achieve what type of size match with the vessel?
A) 1:1 size match
B) A balloon size larger than the vessel diameter
C) A balloon size less than 1:1 with the vessel
D) No specific size match is required
C) A balloon size less than 1:1 with the vessel
Balloon-to-artery ratios of more than what value are associated with increased complications?
A) 1.0:1
B) 1.1:1
C) 1.2:1
D) 1.5:1
C) 1.2:1
What length of balloon is generally used for long and diffuse narrowings?
A) 5–10 mm
B) 10–15 mm
C) 15–20 mm
D) 30–40 mm
D) 30–40 mm
Short balloons (10–15 mm) are typically used for:
A) Long lesions
B) Stent expansion to avoid stretching the vessel wall outside the stent
C) Balloon pre-dilatation of lesions
D) Expanding the coronary artery to match stent size
B) Stent expansion to avoid stretching the vessel wall outside the stent
How is balloon/stent size generally determined?
A) By visual estimation of the reference vessel diameter
B) By the size of the angiographic catheter
C) Using only IVUS or OCT imaging
D) Based on the patient’s age and gender
A) By visual estimation of the reference vessel diameter
According to IVUS studies, the actual vessel diameter is typically ______ compared to the stent size selected using visual estimation.
A) 0.5 mm smaller
B) 0.5 mm larger
C) The same size
D) 1 mm smaller
A) 0.5 mm smaller
Which of the following is not a factor in stent selection for PCI?
A) Device profile
B) Ease of delivery
C) Balloon inflation pressure
D) Restenosis and acute thrombosis rates
C) Balloon inflation pressure
Resistance to balloon/stent catheter forward motion may occur because of:
A) Excessive contrast medium
B) Vessel tortuosity or calcification
C) The patient’s blood pressure
D) Balloon overinflation
B) Vessel tortuosity or calcification
What is the purpose of inflating a balloon for less than 60 seconds during PCI?
A) To minimize the chances of restenosis
B) To prevent damage to the coronary artery wall
C) To allow elastic tissue to relax, stretch, and expand the stent
D) To achieve maximum vessel dilation
C) To allow elastic tissue to relax, stretch, and expand the stent
Unstable or thrombotic lesions are typically inflated at what type of pressure compared to chronic, stable, or calcific lesions?
A) Higher pressure
B) Lower pressure
C) The same pressure
D) No pressure is used for thrombotic lesions
B) Lower pressure
What is the primary function of PCI guidewires?
A) To inflate the balloon
B) To steer the balloon/stent/device to the lesion
C) To monitor the aortic pressure during PCI
D) To inject contrast medium
B) To steer the balloon/stent/device to the lesion
What are the common diameters of PCI guidewires?
A) 0.005–0.010 in
B) 0.010–0.014 in
C) 0.020–0.030 in
D) 0.005–0.020 in
B) 0.010–0.014 in
The stiffness of a guidewire is mainly determined by:
A) The flexibility of the spring tip
B) The diameter of the wire
C) The distance between the central core and the spring tip
D) The length of the wire
C) The distance between the central core and the spring tip
What is the main advantage of a stiff guidewire?
A) Better maneuverability in tortuous arteries
B) Easier to advance through side branches
C) Better torque control and support for difficult stent placement
D) Increased steerability through sharp curves
C) Better torque control and support for difficult stent placement
How does a hydrophilic coating on a guidewire impact its performance?
A) It increases the wire’s radio-opacity
B) It decreases the risk of arterial perforation
C) It increases the ease of wire movement within the balloon catheter and artery
D) It improves the wire’s stiffness
C) It increases the ease of wire movement within the balloon catheter and artery
What is the purpose of radio-opacity on a guidewire?
A) To make the guidewire more flexible
B) To improve visualization of the guidewire during the procedure
C) To allow better torque control
D) To prevent arterial dissection
B) To improve visualization of the guidewire during the procedure
Calibrated radio-opaque marker bands on a guidewire are primarily used for:
A) Improving wire flexibility
B) Indicating the length of the lesion
C) Enhancing torque control
D) Preventing arterial perforation
B) Indicating the length of the lesion
What is the typical length of an exchange guidewire?
A) 140–145 cm
B) 120–145 cm
C) 280–300 cm
D) 145–160 cm
C) 280–300 cm
What is the role of an extension wire in PCI procedures?
A) To replace a guidewire during balloon inflation
B) To create a longer guidewire for exchanging balloon catheters
C) To improve the radio-opacity of the guidewire
D) To provide better flexibility during tortuous artery navigation
B) To create a longer guidewire for exchanging balloon catheters
The use of a shorter guidewire (140 cm) is typically intended for:
A) Crossing chronic total occlusions (CTOs)
B) General purpose navigation and device delivery
C) Performing PCI through small coronary arteries
D) Providing easier movement within the balloon catheter
B) General purpose navigation and device delivery
What is the primary function of an adjustable hemostatic rotating Y-connector valve in PCI?
A) To increase balloon inflation pressure
B) To facilitate contrast injection and pressure measurement
C) To control guidewire torque
D) To provide support for stent placement
B) To facilitate contrast injection and pressure measurement
What is the purpose of the valve in the Y-connector?
A) To assist with balloon catheter placement
B) To minimize back bleeding during catheter insertion or removal
C) To prevent guidewire torque manipulation
D) To prevent vessel dissection
B) To minimize back bleeding during catheter insertion or removal
Balloon inflation devices are used to:
A) Measure arterial pressure
B) Inject contrast into the coronary artery
C) Inflate the PCI balloon to a desired pressure
D) Monitor stent expansion
C) Inflate the PCI balloon to a desired pressure
What is the typical range of inflation pressures required to expand a PCI balloon?
A) 1–2 atm
B) 4–12 atm
C) 10–15 atm
D) 18–20 atm
B) 4–12 atm
When might very high inflation pressures (greater than 18 atm) be required during PCI?
A) When the artery is dilated to a very large size
B) To expand calcified or highly fibrotic lesions
C) When using a balloon with a high compliance rate
D) During stent deployment in large vessels
B) To expand calcified or highly fibrotic lesions
The guidewire torque device is used to:
A) Control balloon inflation pressure
B) Perform fine steering manipulations of the guidewire
C) Provide pressure monitoring during PCI
D) Insert stents into the coronary artery
B) Perform fine steering manipulations of the guidewire
What is the function of a guidewire introducer?
A) To measure balloon inflation pressure
B) To help insert the guidewire through a Y-connector valve or into a balloon catheter
C) To facilitate stent deployment
D) To remove thrombus during PCI
B) To help insert the guidewire through a Y-connector valve or into a balloon catheter
The choice between drug-coated stents (DES) and bare metal stents is primarily based on:
A) Vessel size
B) The clinical scenario and patient-specific factors
C) The type of balloon catheter used
D) The diameter of the stent
B) The clinical scenario and patient-specific factors
The most common stent diameter used in PCI procedures for coronary arteries is:
A) 0.25–2.0 mm
B) 2.25–5 mm
C) 5–10 mm
D) 8–12 mm
B) 2.25–5 mm
What is the unique feature of a covered stent with a polytetrafluoroethylene (PTFE) coating?
A) It is designed for use in peripheral vessels only
B) It helps cover coronary perforations or ruptures and can be used to cover aneurysms
C) It is exclusively used in saphenous vein grafts
D) It is used for bifurcated lesions only
B) It helps cover coronary perforations or ruptures and can be used to cover aneurysms
What is the primary advantage of stenting over balloon angioplasty?
A) Stenting requires less time for the procedure
B) Stenting produces a larger minimal luminal diameter and reduces restenosis
C) Stenting is less expensive
D) Stenting does not require balloon inflation
B) Stenting produces a larger minimal luminal diameter and reduces restenosis
What is the main reason drug-eluting stents (DES) are favored over bare metal stents?
A) DES have a lower risk of thrombosis
B) DES reduce restenosis rates due to the antiproliferative coating
C) DES are easier to deploy
D) DES do not require balloon inflation
B) DES reduce restenosis rates due to the antiproliferative coating
Which of the following materials are stents commonly made of?
A) Stainless steel, cobalt-based alloy, tantalum, titanium, or nitinol
B) Polyethylene, rubber, or silicone
C) Copper, aluminum, or glass
D) Bioabsorbable polymers only
A) Stainless steel, cobalt-based alloy, tantalum, titanium, or nitinol
Self-expanding stents are typically used for:
A) Coronary artery interventions
B) Peripheral vascular disease interventions
C) Balloon angioplasty
D) PCI in small arteries
B) Peripheral vascular disease interventions
What is the main mechanism of expansion for balloon-expandable stents?
A) They expand on their own once deployed
B) They are expanded by inflation of a balloon mounted on the stent catheter
C) They use nitinol memory metal to expand
D) They require no inflation and expand through chemical reactions
B) They are expanded by inflation of a balloon mounted on the stent catheter
What is predilation in the context of stent deployment?
A) Implanting a stent without balloon dilation
B) Inflating a balloon slightly undersized relative to the vessel diameter before stent implantation
C) Expanding the artery using high pressure before stent deployment
D) A technique used only for peripheral vascular interventions
B) Inflating a balloon slightly undersized relative to the vessel diameter before stent implantation
Why is predilation often preferred over direct stenting?
A) It provides a more predictable stent size
B) It requires less equipment
C) It leads to reduced vessel size during balloon inflation
D) It is quicker and saves time
A) It provides a more predictable stent size
Which of the following is a disadvantage of direct stenting?
A) It causes more vessel trauma
B) It may result in suboptimal stent sizing due to poststent vasodilation
C) It increases the risk of restenosis
D) It requires more time than predilation
B) It may result in suboptimal stent sizing due to poststent vasodilation
When would an extra-support guidewire be used in PCI?
A) To increase balloon inflation pressure
B) To provide stronger support for crossing lesions with extreme angulation or calcification
C) To help with stent sizing
D) To guide the stent during balloon expansion
B) To provide stronger support for crossing lesions with extreme angulation or calcification
What is the buddy wire technique used for in PCI?
A) To assist with balloon inflation
B) To straighten the vessel and help deliver the stent catheter
C) To monitor the pressure inside the artery during PCI
D) To prevent vessel dissection during balloon angioplasty
B) To straighten the vessel and help deliver the stent catheter
What is the primary goal of stent optimization?
A) To ensure the stent is implanted without any device-induced damage
B) To expand the stent to its maximal safe extent without causing vessel injury
C) To minimize the use of balloon inflations during the procedure
D) To reduce the risk of stent thrombosis
B) To expand the stent to its maximal safe extent without causing vessel injury
Which of the following methods is essential for evaluating stent optimization?
A) Visual estimation of vessel diameter
B) Measurement of the stent lumen by angiography
C) Evaluation using IVUS/OCT to assess reference vessel and implanted stent dimensions
D) Use of a guidewire to assess the lesion’s crossing difficulty
C) Evaluation using IVUS/OCT to assess reference vessel and implanted stent dimensions
What pressure is typically used during high-pressure balloon dilatation for stent optimization?
A) 4–6 atm
B) 8–10 atm
C) >12 atm
D) 20–24 atm
C) >12 atm
What is the recommended approach when stenting multiple lesions?
A) Stent the proximal lesion first, followed by the distal lesion
B) Stent both lesions simultaneously to save time
C) Stent the distal lesion first, followed by the proximal lesion
D) Stent the lesions in any order
C) Stent the distal lesion first, followed by the proximal lesion
When recrossing a recently implanted stent, what is the recommended method to avoid stent damage?
A) Use a stiff, straight guidewire to advance through the stent
B) Use a large J-wire tip curve or even a loop to ensure the guidewire does not go under the stent
C) Avoid advancing the guidewire at all costs
D) Only use a balloon catheter for recrossing
B) Use a large J-wire tip curve or even a loop to ensure the guidewire does not go under the stent
What should be done if there is residual distal vessel narrowing after stent implantation?
A) Nothing, as it usually resolves on its own
B) A freshly prepared balloon catheter should be advanced through the stented area for further dilatation
C) The procedure should be aborted, and the patient should be referred for surgery
D) The stent should be removed and replaced with a larger stent
B) A freshly prepared balloon catheter should be advanced through the stented area for further dilatation
What is the definition of an acceptable angiographic result after stent deployment?
A) A residual narrowing of more than 20%
B) No residual narrowing
C) A residual narrowing of less than 10% by visual estimate
D) Complete resolution of the lesion without the need for further dilatation
C) A residual narrowing of less than 10% by visual estimate
Which of the following is a potential complication associated with high-pressure balloon inflations during stent optimization?
A) Vessel spasm
B) Decreased stent expansion
C) Increased arterial wall compliance
D) Lack of proper stent apposition
A) Vessel spasm
What is the recommended approach if friction between stents makes it difficult to cross a proximally implanted stent with a balloon catheter?
A) Use excessive force to advance the catheter
B) Consider high-pressure proximal stent expansion, balloon-assisted guide catheter advancement, or a buddy wire method
C) Use a guide catheter without balloon assistance
D) Abort the procedure and perform a bypass surgery
B) Consider high-pressure proximal stent expansion, balloon-assisted guide catheter advancement, or a buddy wire method
What is the most important consideration for stent optimization in small vessels (<2.5 mm in diameter)?
A) Achieving a final stent lumen cross-sectional area (CSA) larger than the distal reference lumen CSA
B) Using a smaller balloon to prevent vessel rupture
C) Deploying the stent without any pre-dilation
D) Inflating the balloon to pressures above 18 atm
A) Achieving a final stent lumen cross-sectional area (CSA) larger than the distal reference lumen CSA
