Ischaemic Heart Disease - Coronary Re-vascularisation Flashcards
what happens in coronary artery bypass?
- enters through median sternotomy
- long saphenous vein
- internal mammary artery
- cardio-pulmonary bypass
- cardioplegia
= risk of Graft disease 8-10 years later
what are the complications of coronary artery bypass graft (CABG)?
- death
- stroke
- MI
- atrial fibrillation
- infection
- cognitive impairment
- sternal malunion
- renal failure
- failure to recover
what is Percutaneous coronary intervention, PCI?
non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries
= a balloon catheter is inserted into the obstructed artery and inflated to relieve the narrowing; stents can be used to keep the blood vessel open
what are complications of PCI?
- death
- stroke
- MI
- renal failure
- bleeding
- vascular complications
- stent thrombosis
- stent restenosis
what happens in the PCI tehcnique?
- Vascular access
- Anti-platelet drugs, anticoagulation
- Catheter to ostium of coronary
- Guidewire down vessel
- Balloons threaded over wire
- Stent(s) implanted
- Balloon, catheter, wires removed
who is suitable for re-vascularisation?
1) multi-vessel disease, diffuse or focal
2) left main disease
3) diabetes
4) co-morbidities
what could go wrong with the Stent insertion in PCI?
- stroke
- contrast
- nephropathy
- bleeding
- failure of stent to;
= deliver
= expand
= to expand without perforation
= to remain patient - to treat all atherosclerosis, and prevent future events
what are 2 specific issues with PCI?
1) dual anti-platelet therapy
2) vascular access
what is radial artery access?
dual supply to hand, superficial and compressible
is radial artery access superficial or deep?
superficial
what are 3 problems that could arise from radial artery access?
1) smaller
2) prone to spasm
3) occlusion (asymptomatic)
wha is the biggest risk of using femoral artery?
haematoma = life threatening
how would you treat STEMI?
= primary PCI
how would you treat coronary syndrome?
= angiography with a view to re-vascularisation
how would you treat sable angina?
= re-vascularisation for severe symptoms or high risk
