Orbital Atherectomy ETC. Flashcards
What is the gold standard for detection of intracoronary thrombus?
Fiberoptic angioscopy
What is an alternate method for detection of intracoronary thrombus if fiberoptic angioscopy is not available?
IVUS or OCT
Thrombus is recognized as what kind of mass on IVUS and OCT?
Low echogenic mass with globular or layered appearance protruding
What device do you use to aspirate the intracoronary thrombus? (2)
-Manual Aspiration Catheters
-High Pressure rheolytic Thrombectomy System
Mechanical aspiration Thrombectomy devices are?
(3)
Dual lumen
Over 0.014 guidewire
6F or 7F
What is the most frequently used aspiration thrombectomy catheters? (3)
-Export XT Aspiration Catheter
-Extract Catheter
-Pronto V3 Extraction Catheter
How should mechanical aspiration be performed?
Antegrade fashion from proximal to distal while crossing the lesion.
Mechanical aspiration can repeat multiple times as long as the collection of thrombus into what?
Lockable syringe
Continuous aspiration ensures what?
-No premature release of the distal thrombus into proximal, other coronary branches, or aortic root.
Operators should do what to ensure large thrombus particles are not attached to the tip of the aspiration catheter?
Sufficient back-bleeding at the end of aspiration to ensure that the guide catheter and connector are clear of thrombus.
What is the difference between the penumbra and aspiration thrombectomy catheters?
Penumbra is attached to a pump that allows stronger continuous suction for removal of the thrombus instead of a syringe
When is it recommended to use aspiration thrombectomy?
Vessels with a large thrombus burden
What develops atherosclerotic luminal disease much more commonly than arterial grafts?
SVGs
Half of SVGs within 10 years develop what?
Complete or significant occlusion
PCI is preferred over redo CABG on SVGs because of?
Inherent risks of repeat surgical revascularization.
What is the most concerning technical challenge in PCI on SVGs?
No reflow phenomenon
Why has embolic protection devices been made?
To prevent or minimize distal embolization in no reflow phenomenon
What is the most common embolic protection system?
Filterwire EZ (Boston Scientific)
What medication can have a beneficial role in treating no reflow phenomenon?
Adenosine or Nicardipine
How far does the filter expand to in Filterwire EZ embolic protection system?
5.5 mm
What must you do to deploy the Filterwire Embolic protection device?
Crossing the lesion and placing it distal to the lesion before deploying.
What is the major limitation for embolic protection systems?
Adequate landing zone which is approximately 25 to 30 mm distal to the edge of the lesion.
What are the ranges of the SpiderFX embolic protection device in size?
3.0-7.0 mm
What guidewire can the SpiderFX use?
0.014 inch guidewire
What guide catheter does teh SpiderRx get delivered from and retrieved from?
-3.2 F Rapid exchange system
-4.2F or 4.6F Retrieval catheter
