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R9 > Chapter 61 - Endovascular therapeutic techniques > Flashcards

Chapter 61 - Endovascular therapeutic techniques Flashcards

1
Q

Single-operator exchange system balloon

A

Monorail Rapid exchange wire exits from side hole 20-25 cm proximal to balloon

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2
Q

Pro and con of single-operator exchange system

A

1) less pushability 2) lower profile 3) single operator 4) cannot exchange wire with it

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3
Q

material of POBA

A

plastic polymer usually

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4
Q

Compliance definition

A

degree of expansive ability of the balloon

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5
Q

Nominal pressure

A

Pressure at which balloon expands to determined diameter and length

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6
Q

Rated burst pressure define

A

< 1% of test balloons will burst beyond this point

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7
Q

Mean burst pressure

A

when 50% balloons will rupture

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8
Q

Compliant balloon material

A

polyolefin copolymer polyethylene

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9
Q

Compliant balloon pro and con

A

1) better trackability 2) single balloon can be used for different sizes 3) doggie bone effect that can damage nearby vessel segments 4) provides less damage overall

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10
Q

Non-complaint balloon pro and con

A

= high pressure or low compliance balloons 1) improved radial force 2) maintain design and shape under high pressure 3) higher burst pressure

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11
Q

Non-compliant balloon material

A

Polyethylene terephthalate nylon reinforced polyurethane

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12
Q

Trackability pushability crossability definition

A

Trackability = over wire pushability = transmit force along length to lesion crossability = ability to cross stenotic lesion

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13
Q

Uses of cutting balloons

A

1) short lesions 2) venous graft stenosis 3) bifurcation stenosis 4) no stenting zone 5) in-stent restenosis 6) HD AVF lesions 7) fem pop lesions

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14
Q

Cryoplasty

A

liquid NO to generate -10C for balloon plasty no evidence

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15
Q

LEVANT 1 trial

A

1) single blinded Lutonix DCB study for fempop 2) 101 patients 3) Rutherford class 2-5 4) primary = angiographic late lumen loss 6 months 1) primary patency 72 vs 49% 6 months 2) primary patency 67 vs 55% at 12 months based on freedom from TLR, angiographic restenosis and PSVR > 2.5

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16
Q

Lutonix DCB drugs

A

paclitaxel 2 mcg/mm2

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17
Q

LEVANT 2

A

1) single blinded RCT 2) lutonix vs PTA 3) 476 patients 4) primary patency 65.2 vs 52.6%

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18
Q

Who made the first stent

A

Charles stent - british dentist for dental molds

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19
Q

First PTA done by

A

Charles Dotter 1964

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20
Q

First balloon-expandign stent made by

A

Palmaz 1985

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21
Q

Current iliac stents - table

A

TABLE 61.1

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22
Q

Current SFA stents - table

A

TABLE 61.1

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23
Q

Material of balloon-expandings tents

A

1) stainless steel 2) cobalt-chromium

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24
Q

Benefit of cobalt chromium over stainless steel

A

1) Greater radial force 2) lower crossing profile 3) enhanced flexibility

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25
Q

Material of self-expanding stent

A

Nitinol nickel titanium alloy

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26
Q

Unique feature of the wallstent

A

Can be repositioned and resheathed

27
Q

Unique feature of the misago (terumo) stent

A

not overthe wire

28
Q

Pro and con of open cell confirgurationg stent

A

1) flexible 2) suscepitible to deformation 3) can bend 4) prone to plaque protrusion through strut 5) better trackability in tortuous segments

29
Q

Approval of use for the Advanta V12

A

tracheobronchial strictures PTFE encased stainless steel

30
Q

Jostent

A

Abbott 0.014 system two stainless steel stents on PTFE bail out only

31
Q

VIPER trial

A

Test Viabahn in long SFA occlusion single arm primary patency 73%

32
Q

VIASTAR trial

A

Viabahn in RCT for SFA lesion primary patency 63.1 vs 40 for BMS even better for longer lesions

33
Q

Viabahn Flair Vluency indication and design

A

Viabahn - vascular; nitinol encased in PTFE Flair - nitinol and PTFE, use in HD for AV graft anast stenosis Fluency - biliary application; luminexx (nitinol) in PTFE; stent flairs at the last 2mm

34
Q

DES types and evidence

A

SMART stent (sirolimus; cordis) - SIROCCO I and II trials : no difference in restenosis Dynalink stent (Abbott; everolimus) - STRIDES trial : no difference Zilver PTX (Cook; paclitaxel) - trial = improved patency up to 5 years Eluvia (Boston; paclitaxel based on innova stent) = IMPERIAL trial non inferior

35
Q

Multilayer flow modulator

A

1) exclude aneurysms 2) 3 dimentional braided tube with multilayer wire and no covering prosthesis 3) Cardiatis MFM 4) patency 87%; aneurysm thrombosis 93%

36
Q

Bioabsorbable stents key points

A

1) Igaki-Tamai (poly-L lactic acid) in coronary: promising 2) Biotronik (alloy with magnesium and others) 3) INSIGHT trial to test biotronik - no benefit over POBA

37
Q

SilverHawk/TurboHawk

A

Directional Arthrectomy device cutting blade rotate 8000 rpm DEFINITIVE Ca++ study: good single arm efficacy and safety profile

38
Q

Pathway jetstream

A

Rotational atherectomy drill with fluid infusion and aspiration port for debris PATHWAY trial - good success without serious events

39
Q

Diamondback 360

A

Orbital atherectomy system diamond-coated crown that orbits to break debris CONFIRM registry - benefit

40
Q

CVX300 Excimer

A

Laser arthrectomy device 308 nm wavelength

41
Q

Thromboembolectomy technologies

A

1) Fogarty balloon 2) Aspiration: Export, PriorityOne, Pronto 3) Rheolytic: Angiojet with vacuum (PEARL registry) 4) rotational: rotarex, trellis infusion catheter (hybrid of thrombolytic and aspiration with balloon trapping of treatment area) 5) Ultrasound enhanced: Ekosonic (SEATTLE II study) - microsonic device with drug delivery 6) others: Solitaire (mechanical thrombectomy with drug delivery) - Trevo stent retriever device - Indigo = vacuum

42
Q

Devices to cross CTO

A

1) Crosser (Bard): high frequency mechanical recanalization - PATRIOT trial 2) TruePath (Boston): rotating diamond-coated tip 3) Frontrunner XP (Cordis):

43
Q

Re-entry devices

A

1) Outback (Cordis): needle redirection 2) Pioneer (Volcano): IVUS guided 3) Enteer (Covidien): flat balloon + needle 4) Offfroad (Boston): balloon redirection

44
Q

Pushable coils

A

0.035 Tornado (Cook) MReye (Cook) 0.018 Tornado (Cook) Diamond (Boston) Trufill (Codman)

45
Q

Detachable coils

A

0.035 Flipper (Cook) Interlock (Boston) 0.018 GDC (Stryker) Target (Stryker) Interlock (Boston) Cashmere (Codman) Matrix 2 (Boston) Cerecyte (Micrus) Azur (Terumo)

46
Q

Plugs and size range

A

Amplazer 3-22 mm length 6-18 mm

47
Q

Oversizing of coils

48
Q

Liquid embolic agents

A

1) Cyanoacrylate (NBCA) 2) fibrin sealant 3) Ethylene vinyl alcohol

49
Q

Exoseal closure device

A

Cordis Bioabsorbable polyglycolic acid plug absorbs in 60-90 days ECLIPSE trial

50
Q

FISH closure device

A

Femoral introducer sheath and hemostasis bioabsorbable extrallular matrix of porcine small intestinal submucosa Morris Innovative

51
Q

Mynx duration

A

30 days before dissolve

52
Q

Prostar XL sizes

A

8.5 to 10 Fr closure

53
Q

Proglide Fr sizes

A

5-8Fr with one up to 21 with two

54
Q

typical balloon sizes for different arteries

A

TABLE 61.3

55
Q

foot angiosome

A

FIGURE 61.5

56
Q

Grades of dissection after POBA

A

Grade A: small radiolucent area with lumen of vessel disappearing with passage of contrast materal Grade B: filling defect parallel to lumen of vessel, disappears with passage of contrast Grade C: dissection protruding inside lumen; persists Grade D: spiral shaped defect with delayed run off distally Grade E: persistent luminal filling defect and delayed antegrade flow Grade F: filling defect with total occlusion

57
Q

Stent needed for which grades of dissection after POBA

A

Grade C to F as long as contrast persists

58
Q

First subintimal angioplasty

A

Bolia 1989

59
Q

CART technique

A

Controlled antegrade and retrograde subintimal tracking requires two balloons to crack the plaque

60
Q

When to use a stent in POBA

A

1) > 30% resitual stenosis 2) dissection Grade C+ 3) acute occlusion

61
Q

Types of stent fractures

A

Type 0 = no # Type 1 = single strut # Type 2 = multiple strut # Type 3 = multiple strut # with stent transection Type 4: includes displacement of segments and spiral #

62
Q

Pro and con of balloon-expandable vs self-expanding stents

A

TABLE 61.4

63
Q

Oversizing self-expanding stents

64
Q

three steps of coil embolization

A

Framing (20% oversize) Filling Finishing

R9 (200 decks)

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