high yeild points abbott course Flashcards
What size balloons do you need in general for peripheral vessels a. inflow
b. outflow
a. common iliac 10-12
b. EIA 8-10
c. CFA 7-9
d. SFA 6-8
e. pop 4-6
How many pcis in use
about a million
What percentage of patients have ISR at 3 years NCDR?
10%
How much does imaging cut down ISR
50%
What are 3 goals with imaging in recent ultimate trial
CSA >5
No major edge dissection involving the media
no plaque burden 50% at either edge within 5 mm of stent edge
all current stents are what drugs
limus (sero, evero, zotero)
ISR considerations?
Change stent type.
Cilostazol (makes plavix more effective)
oral sirolius
Croce’s (crow-sh) brigham algorithm for stent failure:
- Image first - what is mechanism and what is size of CSA. Will a 2 mm laser go through a 1.9 mm lesion (no)
- fork in the road- underexansion (expand)
vs. intimal hyperplasia - hopefully will have DCB soon. - underexpansion - balloons tend to slip use scoring (less rupture), angiosculpt and choclate and can also wolverine. SHort balloons give better PSI.
- Also with intimal hyperplasia want scoring so doesnt slide
what is onion skinning?
adding layer on layer of stent making diameter smaller.
Croce typical frequency and fluency
USually use 0.9 (Set 80/80), 1.4 fiber only does a 60/40. If laser on contrast it makes it much better. Instent turn it up all the way and he gives contrast. with the 0.9 the diameter only goes out about 2 mm.
perf femoral what is first step
6-8 mm balloon (choose 7) and fill artery also hold pressure and wait. Make sure balloon is over perf. ? reversal.
THM with ISR from neointimal hyperplasia
need DCBs then if that fails brachy
Problems with spasm what guides can really help
Ikari
If going to super high pressure what should you do with the balloon
Prep your own balloon
Algorithm for dealing with a stuck guide
- dont panic
- sedate the crap out of them (to bagging)
- SL nitro, nitropaste to the arm
- put in dilator (use railway)
- Nerve block (you need to learn how to do
- blood pressure cuff up supersystolic x 5 min
6.
What do we do with radiation
good sedation and high ACT since almost occlusive
What size burr does croce use for stent roto
1.25 and use higher rpms to decrease chance of sticking. Jason wollmuth larger burrs to make sure you ablate stents
Kink in guide what do you do?
back of the wire and counter out. Need to watch pressure. IF in the arm can put bp cuff up and
dapt for brachy
keep on indefinitely.
2 Golden rules for guide selection in PCI
- Use 7fr for bif
2. Use AL 0.75 for the right.
caviat for rotaing within stent
dont do it in a fresh stent. could pull it out with the rota.
Jason Wollmuth rule for guide selection for RCA
only use AL guides only, IF ostial lesion then can use JR4 and then
2 advices for DK crush that Dr parikh gave
make sure POT prior and leave enough stent proximal to fit at least an 8 mm post dil balloon
how to be more efficient in dk crush
call for 3 wires 2 balloons and micro catheter upfront. 7 fr guide.
behind trapped wire want to make sure can pull out so
dont leave a loop on the wire dont trap a wiggle
push test on guide
pop out to test guide support
snare types
goose neck
loose stent first step
- consider if you can deploy.
- `1.0 saphine beyond and inflate then try to pull back.
- snare good neck
- combo balloon and good neck.
- Crush against the side
see CCI brilakis 2005
Questions for interviews
- mentorship in lab
- weekend schedule
- How is the relationship with the hospital
- Money
- lifestyl
- How does group deal with a bad outcome
- compensation based on schedule
have a bad outcome what do you do with referring; family
pick up phone immediately; talk to family
minimal acceptable ivus sizes
LM 8 mm
point of confluence 7 mm
LAD ostium 6 mm2
Ostial LCX 5 mm2
5 steps to dealing with perfs
- Balloon up
- IVF wide open
- PRessures mixed up
- tray on fleld regardless
- call for help (attending, anesthesia)
