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Cath Sap 5 board prep > high yeild points abbott course > Flashcards

high yeild points abbott course Flashcards

1
Q

What size balloons do you need in general for peripheral vessels a. inflow
b. outflow

A

a. common iliac 10-12
b. EIA 8-10
c. CFA 7-9
d. SFA 6-8
e. pop 4-6

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2
Q

How many pcis in use

A

about a million

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3
Q

What percentage of patients have ISR at 3 years NCDR?

A

10%

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4
Q

How much does imaging cut down ISR

A

50%

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5
Q

What are 3 goals with imaging in recent ultimate trial

A

CSA >5
No major edge dissection involving the media

no plaque burden 50% at either edge within 5 mm of stent edge

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6
Q

all current stents are what drugs

A

limus (sero, evero, zotero)

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7
Q

ISR considerations?

A

Change stent type.
Cilostazol (makes plavix more effective)
oral sirolius

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8
Q

Croce’s (crow-sh) brigham algorithm for stent failure:

A
  1. Image first - what is mechanism and what is size of CSA. Will a 2 mm laser go through a 1.9 mm lesion (no)
  2. fork in the road- underexansion (expand)
    vs. intimal hyperplasia - hopefully will have DCB soon.
  3. underexpansion - balloons tend to slip use scoring (less rupture), angiosculpt and choclate and can also wolverine. SHort balloons give better PSI.
  4. Also with intimal hyperplasia want scoring so doesnt slide
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9
Q

what is onion skinning?

A

adding layer on layer of stent making diameter smaller.

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10
Q

Croce typical frequency and fluency

A

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.

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11
Q

perf femoral what is first step

A

6-8 mm balloon (choose 7) and fill artery also hold pressure and wait. Make sure balloon is over perf. ? reversal.

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12
Q

THM with ISR from neointimal hyperplasia

A

need DCBs then if that fails brachy

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13
Q

Problems with spasm what guides can really help

A

Ikari

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14
Q

If going to super high pressure what should you do with the balloon

A

Prep your own balloon

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15
Q

Algorithm for dealing with a stuck guide

A
  1. dont panic
  2. sedate the crap out of them (to bagging)
  3. SL nitro, nitropaste to the arm
  4. put in dilator (use railway)
  5. Nerve block (you need to learn how to do
  6. blood pressure cuff up supersystolic x 5 min
    6.
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16
Q

What do we do with radiation

A

good sedation and high ACT since almost occlusive

17
Q

What size burr does croce use for stent roto

A

1.25 and use higher rpms to decrease chance of sticking. Jason wollmuth larger burrs to make sure you ablate stents

18
Q

Kink in guide what do you do?

A

back of the wire and counter out. Need to watch pressure. IF in the arm can put bp cuff up and

19
Q

dapt for brachy

A

keep on indefinitely.

20
Q

2 Golden rules for guide selection in PCI

A
  1. Use 7fr for bif

2. Use AL 0.75 for the right.

21
Q

caviat for rotaing within stent

A

dont do it in a fresh stent. could pull it out with the rota.

22
Q

Jason Wollmuth rule for guide selection for RCA

A

only use AL guides only, IF ostial lesion then can use JR4 and then

23
Q

2 advices for DK crush that Dr parikh gave

A

make sure POT prior and leave enough stent proximal to fit at least an 8 mm post dil balloon

24
Q

how to be more efficient in dk crush

A

call for 3 wires 2 balloons and micro catheter upfront. 7 fr guide.

25
Q

behind trapped wire want to make sure can pull out so

A

dont leave a loop on the wire dont trap a wiggle

26
Q

push test on guide

A

pop out to test guide support

27
Q

snare types

A

goose neck

28
Q

loose stent first step

A
  1. consider if you can deploy.
  2. `1.0 saphine beyond and inflate then try to pull back.
  3. snare good neck
  4. combo balloon and good neck.
  5. Crush against the side
    see CCI brilakis 2005
29
Q

Questions for interviews

A
  1. mentorship in lab
  2. weekend schedule
  3. How is the relationship with the hospital
  4. Money
  5. lifestyl
  6. How does group deal with a bad outcome
  7. compensation based on schedule
30
Q

have a bad outcome what do you do with referring; family

A

pick up phone immediately; talk to family

31
Q

minimal acceptable ivus sizes

A

LM 8 mm
point of confluence 7 mm
LAD ostium 6 mm2
Ostial LCX 5 mm2

32
Q

5 steps to dealing with perfs

A
  1. Balloon up
  2. IVF wide open
  3. PRessures mixed up
  4. tray on fleld regardless
  5. call for help (attending, anesthesia)

Cath Sap 5 board prep (12 decks)

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