Long Lesions and Diffuse Disease Flashcards
What is diffuse coronary atherosclerosis associated with in patients with CAD?
Increased severity of inducible myocardial ischemia and risk for serious adverse events
Diffuse CAD impacts myocardial perfusion and is distinct from focal CAD.
What does coronary flow reserve (CFR) integrate?
The hemodynamic effects of focal epicardial coronary stenosis, diffuse atherosclerosis, and microvascular dysfunction on myocardial perfusion
CFR is calculated as the ratio of hyperemic to rest absolute myocardial blood flow.
What is the common outcome of incomplete CABG revascularization in patients with diffuse CAD?
Significant clinical improvement with an acceptable graft occlusion rate of 19% at 1 year
This includes improvements in angina severity and maximum oxygen uptake.
What are the graft occlusion rates for internal mammary artery grafts compared to SVGs in the LAD distribution?
Lower occlusion rates for internal mammary artery grafts compared with SVGs
Graft occlusion rates do not significantly differ between LAD and non-LAD territories.
What is the initial experience with drug-eluting balloons (DEB) for treating diffuse CAD?
DEB is associated with MACE, TVR, and TLR rates similar to those seen with a DES-alone approach at long-term follow-up
This applies to both smaller-diameter vessels and in combination with DES for long disease.
What was observed with EES implantation in patients with long, diffuse native CAD?
Greater angiographic in-segment late loss and higher rates of in-segment restenosis compared to SES implantation
Clinical outcomes and stent thrombosis rates were similar.
What are the predictors of major adverse cardiac events (MACE) after FMJ procedures?
LV dysfunction and stent length >80 mm
Event-free survival rate for cardiac death, MI, or TLR is approximately 72% at 8 years.
How is FMJ defined?
Placement of overlapping coronary stents in at least one coronary artery with total stent length of ≥60 mm
Most FMJs are in the RCA distribution.
What is the thickness of struts in BVS compared to present-generation DES?
156 μm thick, which is twice the size of present-generation DES
BVS deployment involves precise placement of markers for optimal deployment.
What is the role of orbital atherectomy in radial artery access?
Can be used through a 6- or 7-Fr guide catheter
Ultrasound measurement of the radial artery can assist in determining appropriate sheath size.
According to ACC/AHA and SCAI, how are lesions classified based on length?
Lesions <10 mm are discrete, 10-20 mm are tubular, and >20 mm are considered long
This classification aids in treatment decisions.
What characterizes Type A lesions?
Discrete and <10 mm in length
Type B lesions are 10 to 20 mm in length, while Type C lesions are >2 cm.
What were the TLF and TLR rates reported in Lee et al.’s study over a median of 5 years?
TLF of 16% and TLR or occlusion rates of 8.6%
These are within the accepted range for complex PCI with contemporary DES.
What is the sensitivity of traditional noninvasive modalities in detecting transplant vasculopathy?
Insensitive compared to IVUS, which is the gold standard
Significant lesions are rare in the first 5 years post-transplant but increase thereafter.
What is the most important factor for in-stent restenosis in long stenoses according to Hong et al.?
Stent lumen cross-sectional area by IVUS
Other factors include vessel diameter and overlapping stents.
What is the relationship between stent length and the risk of stent thrombosis?
Increased stent length predicts an increased risk of stent thrombosis
This was demonstrated in analyses of both BMS and DES.
What intervention has been shown to reduce periprocedural MI and MACE at 1 year during PCI?
Infusion of tirofiban
This finding comes from the prospective, randomized, multicenter PETITION study.
What ongoing studies are investigating the efficacy of BVS versus DES in long lesions?
ABSORB-LONG and Compare Absorb studies
These studies aim to provide insights into treatment for diffuse long coronary artery disease.
What is the incidence of definite scaffold thrombosis in acute coronary syndrome patients?
2.6%
ACS is a predictor of stent thrombosis.
What does IVUS evaluation help in the context of diffuse disease?
Selecting an appropriate stent
It allows for accurate assessment of negative remodeling versus plaque burden.
