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Evaluation of the Cardiac System > Intravascular Imaging > Flashcards

Intravascular Imaging Flashcards

1
Q

What is IVI?

A

Intravascular imaging

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2
Q

What does IVI complements?

A

Conventional Angiography to further characterize plaque morphology and optimize performance of PCI

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2
Q

What is the inherent limitations of imaging in Coronary Angiography

A

3 dimensional structure using a 2 dimensional lumenogram

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3
Q

What is IVUS?

A

Intravascular ultrasound

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4
Q

When was IVUS first developed and the first use? (2)

A

-1970s
-1988

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5
Q

What is OCT?

A

Optical coherence tomography

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6
Q

What is the current estimated usage of IVI in all PCI procedures?

A

<15%

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7
Q

What does IVUS employ the use of?

A

Intravascular catheter mounted with a piezoelectric crystalline transducer to generate ultrasound pulses that provides real time 360 degree cross sectional images

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8
Q

IVUS imaging offers characterization of what? (3)

A

-Intracoronary pathology
-Plaque morphology
-Vessel Wall architecture

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9
Q

What are the engineering designs for IVUS? (2)

A

-Solid State
-Mechanical State

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10
Q

What are solid state catheters composed of?

A

Phased array transducer elements in a circular manner at the distal tip

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11
Q

What is the mechanical state catheter is composed of?

A

Rotating component for uniform signal transmission and acquisition

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12
Q

What is the most common pull back method for IVUS?

A

Manual pull back

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13
Q

What is the preferable pull back method and why?

A

-Automated Pull Back
-Pulls back at a constant rate which allows measurement of lesion length.

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14
Q

What is the speed range of automatic pull back? (2)

A

-0.5 to 1.00 mm/s
-up to 10 mm/s in newer devices

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15
Q

What does newer generation IVUS models range from in Mhz

A

20-60 MHz

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16
Q

How is tissue penetration determined in IVUS (2)

A

-Frequency
-As frequency is increased, penetration distance is decreased.

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17
Q

What can air bubbles in between the catheter sheath and IVUS transducer during rotation of mechanical catheters do?

A

Degrade the IVUS images

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18
Q

What is the spatial resolution of IVUS in wavelength and beam width historically?

A

70 micrometers

19
Q

What are OCT catheters designed to emit and recieve?

A

Near infrared light waves through a rotating single optical fiber and imaging lens.

20
Q

What does OCT currently have? (3)

A

Highest resolution
-10-20 micrometers axial
-20-90 micrometers lateral

21
Q

How many times greater are OCT to IVUS in imaging resolution but at what cost? (2)

A

-nearly 10 times greater
-At the expense of lower penetration depth (OCT 1-2 mm, IVUS 5-6 mm)

22
Q

What is the use of OCT predication on?

A

Bloodless imaging through vessels have been cleared of blood by contrast

23
Q

What can effect OCT images due to inadequate clearing of blood by contrast? (3)

A

-Ostial lesions
-Large or small vessels
-severe stenoses

24
Q

What does IVUS not require unlike OCT?

A

Use of contrast for blood clearance

25
Q

What is preferred in larger vascular structures such as the left main coronary artery?

A

IVUS due to enhanced tissue penetration in non calcified vessels

26
Q

What cannot be accurately assessed with OCT?

A

Residual plaque burden at stent edges due to limited depth of penetration

27
Q

What can be specifically helpful in treating patients with chronic kidney disease?

A

IVUS due to not requiring contrast

28
Q

What can OCT resolution allow in stent restenotic lesions?

A

Further characterization including ability to detect neoatherosclerosis

29
Q

Greater resolution of OCT enables what? (3)

A

-Precise locations of side branches, wire locations, and stent visualization

30
Q

OCT is less prone to what?

A

Artifact

31
Q

OCT affords the ability to do what in heavily calcified stenoses

A

Ability to measure and characterize

32
Q

What is used to assess plaque composition and key lesions, and landing zones before intervention

A

IVI (Intravascular Imaging)

33
Q

When should imaging be performed with administration of intracoronary nitroglycerine

A

After administration and should begin 20 mm or more distal to the area of interest and end at the LM or Right coronary artery ostium

34
Q

What can be done if the imaging catheter fails to cross the lesion and PCI is planned?

A

Low pressure undersized balloon pre dilation or atherectomy to facilitate catheter passage

35
Q

What does IVI improve for stents? (5)

A

-Detection
-Localization
-Quantification
-Characterization
-Expansion

36
Q

What are the imaging strategies that are proposed for the selection of stent diameter? (4)

A

-Mean reference lumen
-Largest reference lumen
-Mean mid wall reference
-Smallest reference external elastic lamina

37
Q

What is the morphological characteristics associated with stent under expansion for IVUS? (4)

A

-Superficial calcium angle >270 degrees
-360 degrees of superficial calcium
-Calcified nodule
-Vessel diameter <3.5 mm

38
Q

What is the morphological characteristics associated with stent under expansion for OCT? (3)

A

Calcium angle >180 degrees
Calcium thickness >0.5 mm
Calcium length >5mm

39
Q

Stent lengths should be selected to facilitate?

A

Complete lesion coverage from the most normal distal segment to the most normal proximal segment.

40
Q

Stent expansion is a strong predictor of? (2)

A

Future stent patency and subsequent clinical events

41
Q

What is postprocedure IVI used for?

A

-To confirm that optimal procedural endpoints
-Exclude complications

42
Q

When do minor edge dissections become clinically insignificant (2)

A

-<45 degree circumference
-Measuring <2mm in length

43
Q

What is malapposition?

A

Lack of contact of stent struts with the luminal surface area

44
Q

What does acute stent malapposition typical result from?

A

Stent undersizing, most often from CTO lesions and ACS settings

45
Q

When does stent under expansion occur?

A

Deploying an appropriately sized stent at subnominal pressure in the presence of of underlying resistant plaque.

Evaluation of the Cardiac System (10 decks)

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