Basics Of Percutaneous Coronary Interventions Flashcards
What is the primary goal of percutaneous coronary intervention (PCI)?
A) To diagnose coronary artery disease
B) To perform coronary artery bypass surgery
C) To restore blood flow by treating a stenosis in the coronary artery
D) To reduce blood pressure in the coronary arteries
C) To restore blood flow by treating a stenosis in the coronary artery
Which of the following is the first step in the PCI procedure?
A) Inflating the balloon catheter
B) Implanting a stent
C) Inserting the guiding catheter into the coronary ostium
D) Performing a diagnostic angiography
C) Inserting the guiding catheter into the coronary ostium
After the balloon angioplasty, what is typically done next in the PCI process?
A) Administering blood thinners
B) Inserting a guiding catheter
C) Implanting a stent in the coronary artery
D) Performing a follow-up coronary angiogram
C) Implanting a stent in the coronary artery
Which tool is used to confirm full deployment of a stent during PCI?
A) Electrocardiogram (ECG)
B) Intravascular ultrasound (IVUS)
C) Angioplasty guidewire
D) Stent catheter
B) Intravascular ultrasound (IVUS)
What is the general timeline for a patient to resume normal activities after PCI?
A) Within a few hours
B) Within days
C) Within weeks
D) Within a month
B) Within days
Which of the following is a necessary condition for performing PCI as an ad hoc procedure?
A) The patient must be in a stable condition
B) A stent must always be used during PCI
C) The patient must already have had a bypass surgery
D) The diagnostic catheterization must show no stenosis
A) The patient must be in a stable condition
In the PCI procedure, what does the balloon angioplasty catheter do?
A) It provides a stable path for the guiding catheter
B) It creates a new artery bypassing the blockage
C) It inflates to dilate the narrowed stenosis, improving blood flow
D) It assists in the visualization of the coronary arteries
C) It inflates to dilate the narrowed stenosis, improving blood flow
Which of the following is an essential prerequisite before performing PCI?
A) A previous history of heart failure
B) Mastery of basic diagnostic cardiac catheterization techniques
C) A baseline ECG showing ischemic changes
D) Knowledge of pharmacologic agents for blood thinning
B) Mastery of basic diagnostic cardiac catheterization techniques
Which of the following vascular access sites is associated with the lowest risk of access site bleeding during PCI?
A) Femoral artery
B) Ulnar artery
C) Radial artery
D) Subclavian artery
C) Radial artery
What is the most common size of the guide catheter and sheath used in PCI procedures?
A) 5F
B) 6F
C) 7F
D) 8F
B) 6F
Which type of catheter is primarily used during PCI to support the passage of a balloon catheter and stent?
A) Diagnostic catheter
B) Guiding catheter
C) Balloon catheter
D) Rotablation catheter
B) Guiding catheter
When choosing an angioplasty balloon for PCI, what is the primary factor that influences its selection?
A) The weight of the patient
B) The size of the balloon
C) The diameter of the unaffected reference segment of the target vessel
D) The location of the stenosis in the coronary artery
C) The diameter of the unaffected reference segment of the target vessel
Which of the following treatments may be necessary for calcified lesions before stent placement?
A) A special drug-eluting balloon
B) Rotational atherectomy or intravascular lithotripsy
C) A noncompliant balloon
D) Antiplatelet therapy
B) Rotational atherectomy or intravascular lithotripsy
What is the primary function of a balloon-expandable stent?
A) To relieve symptoms of a heart attack
B) To serve as a scaffold after balloon dilation and restore blood flow
C) To dissolve atherosclerotic plaques
D) To increase the diameter of the coronary artery
B) To serve as a scaffold after balloon dilation and restore blood flow
Which imaging technique is commonly used to confirm optimal stent implantation after high-pressure inflations?
A) Magnetic resonance imaging (MRI)
B) Positron emission tomography (PET)
C) Angiography alone
D) Intravascular ultrasound (IVUS) or optical coherence tomography (OCT)
D) Intravascular ultrasound (IVUS) or optical coherence tomography (OCT)
What is the most common method of achieving hemostasis after radial artery access in PCI?
A) Manual compression
B) A pressure band
C) Vascular closure devices
D) External pressure cuffs
B) A pressure band
For femoral artery access, what is the typical method for achieving hemostasis after sheath removal?
A) Pressure band
B) Vascular closure devices
C) Manual compression
D) No intervention is needed
B) Vascular closure devices
After an uncomplicated PCI procedure, how soon can most patients typically return to work?
A) Within a few hours
B) Within 1-2 days
C) Within a week
D) Within a month
B) Within 1-2 days
Which of the following is not an absolute contraindication to PCI?
A) Patient refusal
B) Malfunctioning equipment
C) Small coronary vessels less than 2.5 mm
D) Severe diffuse disease
C) Small coronary vessels less than 2.5 mm
Which of the following is a relative contraindication to PCI?
A) Patient refusal
B) Malfunctioning equipment
C) Small coronary vessels less than 2.5 mm
D) None of the above
C) Small coronary vessels less than 2.5 mm
What factor must be considered when weighing the benefits of PCI versus coronary artery bypass grafting (CABG)?
A) The risk of restenosis and incomplete revascularization
B) The patient’s refusal to undergo PCI
C) The size of the patient’s coronary vessels
D) The need for long-term medication
A) The risk of restenosis and incomplete revascularization
Which of the following is not an anatomic factor associated with poor stent outcomes?
A) Small coronary vessels
B) Vessels with poor distal runoff
C) Vessels supplying poorly functional or nonfunctional myocardium
D) Mild coronary artery disease
D) Mild coronary artery disease
The only absolute contraindications to emergency PCI interventions are:
A) Patient refusal and malfunctioning equipment
B) Severe diffuse disease
C) Small coronary vessels
D) Extensive calcification
A) Patient refusal and malfunctioning equipment
What is one of the most important clinical factors to consider when determining the likelihood of success for PCI?
A) The patient’s age
B) The anatomy and characteristics of the coronary lesions
C) The patient’s history of heart failure
D) The size of the coronary artery stent
B) The anatomy and characteristics of the coronary lesions
Which of the following conditions is associated with a poor PCI outcome?
A) Small coronary vessels
B) Healthy coronary vessels
C) Narrow but flexible vessels
D) Large coronary vessels
A) Small coronary vessels
Restenosis and incomplete revascularization are important considerations in deciding between PCI and:
A) Medication therapy
B) Coronary artery bypass grafting (CABG)
C) Anticoagulation therapy
D) Pacemaker placement
B) Coronary artery bypass grafting (CABG)
Which of the following is not an anatomic concern when considering PCI for patients with complex or high-risk anatomy?
A) Long lesions requiring more than one stent per lesion
B) Significant thrombus at the lesion site
C) Small coronary artery reference vessel diameters (<2.5 mm)
D) Mild stenosis with good collateral circulation
D) Mild stenosis with good collateral circulation
What is the primary risk associated with PCI in patients with long lesions requiring more than one stent per lesion?
A) Increased risk of restenosis
B) Vessel perforation
C) Difficulty achieving optimal stent expansion
D) Higher likelihood of myocardial infarction (MI)
C) Difficulty achieving optimal stent expansion
Which of the following types of lesions is associated with higher-risk PCI?
A) Lesions in saphenous vein grafts
B) Mild, single-vessel disease
C) Lesions with minimal thrombus
D) Distal coronary artery lesions with good collateral circulation
A) Lesions in saphenous vein grafts
What is the incidence of myocardial infarction (MI) as a complication during PCI for most elective procedures?
A) 0.1%
B) 1%–3%
C) 5%–10%
D) 10%–15%
B) 1%–3%
Which of the following is a common complication during PCI that can occur due to femoral access site bleeding, especially with larger sheaths and prolonged anticoagulation?
A) Stroke
B) Vascular injury (e.g., pseudoaneurysm or radial artery occlusion)
C) Acute kidney injury
D) Hypotension
B) Vascular injury (e.g., pseudoaneurysm or radial artery occlusion)
Restenosis after PCI occurs most frequently within the first _______ months after the procedure.
A) 1 month
B) 3 months
C) 6 months
D) 12 months
D) 12 months
Which type of stent is associated with a lower risk of restenosis?
A) Bare metal stents (BMS)
B) Drug-eluting stents (DES)
C) Biodegradable stents
D) Coronary artery bypass grafts (CABG)
B) Drug-eluting stents (DES)
What is the incidence of stent thrombosis, a potentially catastrophic complication of PCI?
A) 0.1%
B) 1%–2%
C) 5%–10%
D) 20%
B) 1%–2%
What is a key factor that increases the risk of stent thrombosis after PCI?
A) Premature discontinuation of dual antiplatelet therapy
B) High-pressure balloon inflation
C) Excessive use of contrast medium
D) Inadequate stent length
A) Premature discontinuation of dual antiplatelet therapy
Restenosis in PCI is more common with which type of stent?
A) Drug-eluting stents (DES)
B) Bare metal stents (BMS)
C) Bioabsorbable stents
D) Covered stents
B) Bare metal stents (BMS)
Which of the following is not one of the three basic pieces of equipment required for every PCI?
A) Guiding catheter
B) Coronary guidewire
C) Defibrillator
D) Balloon/stent catheter system
C) Defibrillator
The primary goal of the guide catheter in PCI is to:
A) Expand the stenotic vessel
B) Deliver the stent to the lesion site
C) Provide a stable platform for guiding the guidewire and balloon/stent catheter system
D) Assess the size of the coronary vessel
C) Provide a stable platform for guiding the guidewire and balloon/stent catheter system
Which of the following is the main function of the coronary guidewire during PCI?
A) To provide support to the guiding catheter
B) To navigate arteries and cross stenoses to deliver the balloon/stent system
C) To implant the stent after balloon inflation
D) To assess vessel diameter
B) To navigate arteries and cross stenoses to deliver the balloon/stent system
The primary challenge when using the balloon/stent catheter system in PCI is to:
A) Determine the patient’s overall health status
B) Expand and implant the stent to the correct vessel size for all plaque types
C) Ensure proper catheter placement
D) Monitor the patient’s heart rate during the procedure
B) Expand and implant the stent to the correct vessel size for all plaque types
What must an operator manage simultaneously during the PCI procedure?
A) Heart rate and blood pressure
B) Guide catheter, guidewire, and balloon/stent catheter system
C) Coronary artery bypass grafts (CABG) and PCI
D) Blood thinning medications and anticoagulants
B) Guide catheter, guidewire, and balloon/stent catheter system
The technique of PCI requires the operator to control which of the following three principal components simultaneously?
A) Heart monitor, angiogram, and balloon catheter
B) Guide catheter, guidewire, and balloon/stent catheter system
C) Diagnostic catheter, pacemaker, and stent
D) Contrast medium, stent size, and heart rate
B) Guide catheter, guidewire, and balloon/stent catheter system
Which type of equipment in PCI is specifically used to expand and implant the stent?
A) Coronary guidewire
B) Guide catheter
C) Balloon/stent catheter system
D) Lesion modification tools
C) Balloon/stent catheter system
What challenge is associated with navigating arteries during PCI?
A) Determining the patient’s need for stent placement
B) Ensuring the guidewire and balloon/stent system can cross the stenosis
C) Administering anesthesia during the procedure
D) Deciding on the appropriate post-procedure medications
B) Ensuring the guidewire and balloon/stent system can cross the stenosis
What is the primary function of the guiding catheter in PCI?
A) To provide a stable platform for the balloon catheter to reach the stenosis
B) To inject contrast medium into the coronary artery
C) To monitor the patient’s heart rate during the procedure
D) To perform angioplasty of the coronary artery
A) To provide a stable platform for the balloon catheter to reach the stenosis
Compared to a diagnostic catheter, the guiding catheter has a:
A) Thicker wall and smaller lumen
B) Thinner wall and larger lumen
C) Thicker wall and larger lumen
D) Thicker wall and smaller lumen
B) Thinner wall and larger lumen
What is one potential drawback of the larger lumen in a guiding catheter?
A) Decreased catheter kinking and increased torque control
B) Decreased catheter strength and increased risk of kinking
C) Improved visualization of coronary arteries
D) Improved torque control and less risk of trauma
B) Decreased catheter strength and increased risk of kinking
Why is the guiding catheter stiffer than a diagnostic catheter?
A) To allow for easier contrast injection
B) To provide support for advancing balloon/stent catheters into the coronary artery
C) To reduce the risk of catheter-induced trauma
D) To increase torque control for guiding
B) To provide support for advancing balloon/stent catheters into the coronary artery
The tip of the guiding catheter is different from the diagnostic catheter tip because it is:
A) Longer and tapered for better maneuverability
B) Shorter and made of a softer material to decrease trauma
C) More rigid to support large balloon catheters
D) Sharper to facilitate crossing difficult lesions
B) Shorter and made of a softer material to decrease trauma
What size guide catheter is most commonly used for routine PCI via the radial artery approach?
A) 5F
B) 6F
C) 7F
D) 8F
B) 6F
When are 7F or 8F guide catheters typically used in PCI procedures?
A) For routine single-vessel coronary interventions
B) When performing complex procedures such as rotablation or bifurcation lesions
C) In patients with small coronary arteries
D) When dual stent positioning is unnecessary
B) When performing complex procedures such as rotablation or bifurcation lesions
What is a potential issue when using smaller (<5F) guide catheters in PCI?
A) They may not allow adequate visualization with some stent systems
B) They have higher torque control
C) They are more rigid and easier to manipulate
D) They allow for higher contrast injection pressures
A) They may not allow adequate visualization with some stent systems
Guiding catheters come in many different shapes to accommodate:
A) The need for specific stent deployment techniques
B) The variety of anatomical variations encountered in daily practice
C) The size of the coronary arteries
D) The length of the procedure
B) The variety of anatomical variations encountered in daily practice
What is the primary function of the guiding catheter during PCI?
A) To deliver contrast media to the coronary arteries
B) To monitor the patient’s blood pressure
C) To deliver the balloon/stent catheter and provide backup support
D) To assess myocardial perfusion
C) To deliver the balloon/stent catheter and provide backup support
What does backing out refer to during PCI?
A) The guide catheter moves too deeply into the coronary ostium
B) The guiding catheter moves out of the coronary ostium when pressure is applied to the balloon
C) The balloon catheter is inflated without advancing across the stenosis
D) The guide catheter is repositioned to ensure coaxial alignment
B) The guiding catheter moves out of the coronary ostium when pressure is applied to the balloon
Which of the following maneuvers increases backup support but carries an increased risk for guiding catheter-induced dissection?
A) Coaxial alignment
B) Backing out
C) Deep seating
D) Use of a guide-within-a-guide system
C) Deep seating
What is the term used for the technique where the guide catheter tip is aligned parallel to the axis of the coronary ostium, optimizing backup support during PCI?
A) Backing out
B) Deep seating
C) Coaxial alignment
D) Guide extension
C) Coaxial alignment
In complex PCI procedures, a guide-within-a-guide system, also called a “mother-and-child guide,” is used to:
A) Provide backup support in difficult situations where the guide catheter cannot reach
B) Inject contrast media more effectively
C) Reduce the risk of guiding catheter-induced dissection
D) Replace the need for balloon catheter insertion
A) Provide backup support in difficult situations where the guide catheter cannot reach
Why is contrast injection through the guiding catheter critical in PCI?
A) To allow the operator to monitor aortic pressure
B) To ensure reliable visualization of the coronary vessel and stenosis during the procedure
C) To prevent the formation of thrombus in the coronary artery
D) To stabilize the guide catheter in place
B) To ensure reliable visualization of the coronary vessel and stenosis during the procedure
What issue might arise when larger PCI devices (e.g., rotoblators) are used with small guide catheters?
A) Inadequate contrast delivery and vessel visualization
B) Excessive torque control
C) Increased likelihood of vessel dissection
D) Reduced balloon catheter effectiveness
A) Inadequate contrast delivery and vessel visualization
What function does the side hole in the guiding catheter serve?
A) To allow blood to enter the coronary artery when the ostium is blocked by the guide catheter
B) To inject contrast medium more effectively into the coronary artery
C) To monitor coronary pressure during PCI
D) To stabilize the guide catheter within the coronary artery
A) To allow blood to enter the coronary artery when the ostium is blocked by the guide catheter
When might the pressure waveform from the guiding catheter show “damping”?
A) When the guide catheter is properly seated coaxially in the coronary ostium
B) When the guide catheter partially or totally occludes the coronary ostium
C) When the balloon catheter is inflated
D) When contrast media is injected into the coronary artery
B) When the guide catheter partially or totally occludes the coronary ostium
Why are guiding catheters with side holes not suitable for assessing fractional flow reserve (FFR)?
A) They create a pseudostenosis that may distort the pressure readings
B) They do not allow for contrast media to flow into the artery
C) They increase the risk of thrombosis
D) They are too rigid to assess hemodynamic lesions
A) They create a pseudostenosis that may distort the pressure readings
There are two types of PCI balloon catheters: over-the-wire (OTW; Fig. 1.6) and monorail or rapid-exchange catheters
