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Year 3 Cardiac physiology > CC5&6: Introduction to intervention and PCI > Flashcards

CC5&6: Introduction to intervention and PCI Flashcards

1
Q

What is HAC service an example of?

A

-Primary PCI for treatment of STEMI

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2
Q

In cath lab where do x rays come from?

A

-Bottom to top

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3
Q

What are features of patient monitoring?

A

-12 lead ECG
-Sats
-NIBP
-Transducer set up

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4
Q

What are the 2 forms of access in PCI?

A

Radial
-Post-procedure sealed with radial band

Femoral
-Closed with closure plug, stitch device, manual pressure

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5
Q

Radial vs Femoral access

A

Radial
-Smaller artery makes advancing catheter more difficult
-Easier to control bleeding

Femoral
-Requires bedrest
-Puncture above bifurcation can cause retroperitoneal bleeding

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6
Q

What are standard drugs in PCI?

A

Lidocaine - local anaesthetic
Verapamil - Prevents vasoconstriction/vasospasm
Heparin - Prevents thrombus
Nitrates - Vasodilation of coronary arteries

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7
Q

Features of simple PCI

A

-Lesion in main vessel
-Landing zones away from branching vessels

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8
Q

Key steps to simple PCI lesions

A

-Supportive guide catheter
-Good guide wire position
-Predilate lesion with balloon
-Stent lesion
-Optimise stent
-Confirm with final images successful PCI with no complications

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9
Q

Diagnostic vs Guide catheters

A
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10
Q

What is standard diagnostic catheter for Angiogram?

A

-Judkins catheter
-Good at obtaining images
-May be used for PCI but not supportive enough (use Amplatz and EBU instead)

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11
Q

What can invasive pressure indicate about catheter position and what would effect be?

A

-Catheter angled towards wall
-Too deeply engaged
-Engaged in area of lesion
-Effect is damping or ventricularisation

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12
Q

How do you know whether LAD or Circ?

A

-In LAO, LAD is on the left
-In RAO, LAD is on the right

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13
Q

What is the O ring?

A

-O ring opened to add and remove angioplasty kit
-O ring causes a false pressure drop due to loss of feedback to transducer

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14
Q

What are guide wires?

A

-Guide wire comes after guide catheter
-Act as a track for other PCI equipment to pass along (e.g. balloons, stent, imaging)

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15
Q

Features of guide wire

A

-3cm radiopaque tip
-helps guide when positioning wire
Aims to identify:
-if guide wire has moved too distal
-selecting a small side branch
-ectopy may indicate wire irritating myocardium

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16
Q

What balloon is used to pre-dilate lesion?

A

Semi-compliant balloons
-Inflated to low pressure
-Conforms to lumen size
-Indicates if lesion is compliant
-Inflated using indeflator - fluid mix of saline and contrast

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17
Q

What does inflating balloon cause?

A

-Temporarily occluding flow
-Causes chest pain and ST elevation

18
Q

What is the structure of balloon catheters?

A

Monorail balloon catheter:
-Guide wire passes through balloon itself
-Exits catheter proximal to balloon

19
Q

What’s the nominal pressure?

A

-Pressure at which balloon reaches its nominal diameter (diameter on label)

20
Q

What’s the rated burst pressure?

A

-Pressure at which balloon will burst according to testing

21
Q

What’s the mean burst pressure?

A

-Mathematical mean pressure at which a balloon bursts

22
Q

What stents used to be used?

A

-Bare metal stents (BMS)
-However, high risk of restenosis

23
Q

What stents are now used?

A

Drug-eluting stents
-Slow release drug coating to prevent cell proliferation
-Preventing fibrosis and thrombus formation which could cause in-stent restenosis

24
Q

Where should stent be positioned?

A

-From normal vessel to normal vessel

25
Q

What are non-compliant balloons used for?

A

-Used to optimise stent
-Ultra high strength to handle overinflation pressures to expand stents

26
Q

What is done post PCI?

A

-Remove all equipment except guide catheter
-Images in two planes to confirm stent well deployed
-Confirm no complications
=>Stent well deployed
=>Good flow to distal vessel
=>No dissection

27
Q

Reasons why PCI would not be simple?

A

-Difficult to pass PCI equipment across lesion
-Is the lesion significant?
-Need more info about pattern of disease
-Lesion does not dilate
-Bifurcation lesions
-Small vessel disease
-In stent restenosis (ISR)

28
Q

What is guide extension?

A

-Used to provide extra support for equipment delivery in tortuous vessels
-However, increased chance of damped pressure trace

29
Q

What does balloon not inflating indicate?

A

-Calcified/heavily fibrosed disease

30
Q

What are cutting balloons?

A

-Have 3 or 4 atherotomes (microsurgical blades) bonded longitudinally
-Dilate to a lower pressure than NC balloons, reducing the extent of vessel wall injury

31
Q

What is rotablation?

A

-Catheter used to shave and remove the luminal calcium or fibrosis in a coronary artery

32
Q

What is shockwave balloon?

A

-Balloon which delivers electrical impulse using a sonic pressure wave to break down calcium

33
Q

What are drug-eluting balloons?

A

-Balloon coated with drug with rapid uptake and prolonged retention
-30sec - 1min inflations to transfer drug to intima
-Commonly used for small vessels, side branches and ISR
-Inflated to low pressure to decrease chance of stenosis
-Longer inflation time means chest pain and ECG changes are common

34
Q

Why are bifurcation lesions more complex?

A

-Treating one vessel’s atheroma/thrombus may narrow or occlude the other vessel

35
Q

What are examples of advances in treating Chronic Total Occlusions (CTOs)?

A

-Advances in guidewire and microcatheter technology
-Antegrade and Retrograde techniques

36
Q

When could restenosis occur and what makes it more likely?

A

-Gradual re-narrowing of stented segments occurs mostly between 3 and 12 months after stent placement
-Caused by exaggerated neointimal formation
-Increased risk in patients with high cholesterol, kidney disease, smoking and uncontrolled diabetes/hypertension

37
Q

What 2 things must we be aware of during STEMI?

A

-Reperfusion can be a high risk time for reperfusion arrhythmias
-RCA - most common bradyarrhythmia
-LAD - most common tachyarrhythmia

-May be high thrombus burden
-Consider thrombus removal device (e.g. Export catheter)
-IV blood thinners (e.g. integrilin)

38
Q

What are some possible risks of PCI?

A

-Dissection/perforation of vessel
-Allergic reaction to medication/contrast
-Irregular heart rhythm
-Infection
-Bleeding at catheter insertion site
-Kidney failure
-Acute closure of coronary artery
-Emergency coronary artery bypass graft (CABG) surgery

39
Q

Why is LIMA good choice for bypass graft?

A

-Left internal Mammary is an artery
-LIMA only has to be sewn once
-LIMA doesn’t have valves

40
Q

What is a good option to treat vein graft stenosis

A

-CTO of native vessel
-Stent in vein would likely restenose

Year 3 Cardiac physiology (30 decks)

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