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Cardio > PCI > Flashcards

PCI Flashcards

1
Q

One yr Stent thrombosis rate with new generation DES

A

<1%

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2
Q

One yr restenosis rate with new generation DES

A

<5%

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3
Q

Rates of very late Stent thrombosis beyond 1 yr

A

0.1-0.2% per year

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4
Q

Rates of very late stent restenosis beyond one year

A

1-2% per year

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5
Q

Theoretical advantage of BRS (bio reabsorbable scaffold ) is

A

Restoring vessel physiology

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6
Q

Length of catheters, normal GW, PTCA wire, Balloon, microcatheter

A

100;145;190; 145; 150

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7
Q

3 types of newer stents

A
  1. Bioreabsorbable polymer DES
  2. Polymer free DES
  3. Bioreabsorbable DES or scaffolds
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8
Q

Stent thrombosis types

A
  1. Late-1 month to 12 months
  2. Early-Less than 1 month
  3. Very late- More than 12 months

ie 2nd month is Late
2nd Year is Very Late

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9
Q

SB occlusion is higher if the angle with main branch is less than

A

45 degrees

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10
Q

SB of —-size should be preserved

A

More than 2mm

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11
Q

Most frequently used bifurcation strategy

A

Provisional T stenting

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12
Q

Strategy for side branch <2.5 mm is

A

Balloon Angio if required to KIO- Keep it open

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13
Q

When to consider elective stenting of SB

A

Size 2.5 mm or more
Lesion more than 3 mm from ostia

Consider in these cases

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14
Q

The inner diameter of 6F,7F& 8F guides are

A

.07 inch, .08 inch and .09 inch respectively

ie one plus

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15
Q

2 stent technique can be done with —–guide

A

7F

One stent and a balloon can be accomadated in a 6 F.( monorail)

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16
Q

In bifurcation which branch to wire first

A

SB as it is usually the difficult one

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17
Q

The main technical concern in 2 stent bifurcation tech is

A

Preventing wire wrapping

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18
Q

Maneuver for removing Amplatz catheter

A

Push and Turn maneuver

NEVER pull back like a Judkins. Will dissect infr wall of Vessel

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19
Q

What is angle Theta in coronary intervention

A

Angle between the JL and opposite wall of Aorta .The inferior angle.

If angle Theta is 90 degree the Cos Theta is 0 So force of dislodgement is less. So greater the angle better the support.
That’s why in TRI JL3.5 gives better support than JL 4 . As angle Theta will be more

Tricks and Tips

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20
Q

Persistent thrombus in PCI. What to do

A

If wire is in lumen,
A. For large thrombus- Thromectomy using Angiojet device
B. For smaller and distal thrombus-Aspiration
If still thrombus…
C. Can give intracoronary rTPA 5mg ever 5 mts to a max dose of 50 mg ? some say 25 mg max
Then if coronary is clean Heparin infusion for 24 hrs and maintain ACT above 200
If coronary is not clean (thrombus or distal flow suboptimal)Intracoronary bolus of 2b3a followed by infusion for IV 12 hours

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21
Q

Preferred bifurcation tech when LMCA is short or in Emergency

A

V stenting

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22
Q

Coulette technique is indicated inLM when

A

LM/LCx angle is less than 60

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23
Q

Treatment of kink site stenosis of LIMA in CABG

A

Usually resolves spontaneously.

To treat only if ischemic sequelae

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24
Q

Order and site of putting grafts in CABG

A

RCA grafts -attached to Rt side of Aorta. So use LAO view

Left sided grafts- LAD, Diagonal, LCx in that order. LAD closest to Aortic valve. From ANTERIOR aspect of Aorta. So use RAO view

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25
Q

Diameter of normal adult LIMA

A

1.9-2.6 cm

While SVG is 3.1-8.5 cm

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26
Q

Gold standard for calcification lesions

A

Rotational atherectomy

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27
Q

Stent grafts may shorten upto____% on inflation

A

25%

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28
Q

Burr to artery ratio when rotablation done prior to stenting

A

0.6-0.7/1

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29
Q

Intermediary coronary stenosis means

A

B/w 40-80%

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30
Q

How to untwist a twisted guide

A
  1. If possible push it into a larger area like Aorta from a smaller branch
  2. Gently push an .035 wire through the twisted area
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31
Q

How to change a guide with wire across a lesion

A
  1. Extend the wire
  2. While injecting CONTRAST from a syringe; pull Guide out retaining PTCA wire.
    Then insert the new guide through 0.035 wire keeping PTCA wire in position.
    Then finally reinsert the Guide though a balloon catheter
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32
Q

D2B time in PPCI

A

Less than 90 mts

Further reduction may not result in better outcomes

Now D2B is not preferred. FMC -first medical contact (ie time at which someone makes the ECG diagnosis) is used 2017

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33
Q

The skin crease in thigh is distal to CFA bifurcation in ……..%

A

70%. .CFA bifurcation was on an average 6mm above skin crease.

Esp obese

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34
Q

Skin nick site for FA puncture flouroscopically

A

Inferior border of femoral head

Puncture at center of femoral head

35
Q

Heparin dose in TRA Angio

A

50 units/kg

36
Q

NTG and Diltiazem inTRA

A

N-100-200 mcg

D- 2-5 mg

37
Q

Radial artery occlusion rate in TRA

A

5%

Higher rates with routine Doppler

38
Q

Complications with ulnar access

A

Nerve injury more likely

Don’t do after failed ipsilateral radial attempt

39
Q

Site of brachial access

A

2-3 cm above elbow crease

Medial aspect of cubital fossa

40
Q

Femoral vein insertion site

A

2cm below Ing ligament, not the crease

41
Q

Preferred arm Position in Subclavian access

A

Abducted

42
Q

When RCA or LCA originates from the opposite Sinus the 4 routes taken are

A
  1. Septal - Most common
  2. Retroaortic
  3. Anterior
  4. Interarterial- Least common and most serious one
43
Q

How to identify septal pathway of an anomalous course of coronary

A

RAO view
Fish hook picture

Because LM goes down to septum and then comes up in the epicardium

LCx then would curve backwards and form the eye with LCx as upper border

44
Q

View for differentiating different anomalous coronary courses

A

RAO 30

45
Q

Most dangerous course of anomalous LMCA is seen in CAG as

A

RAO 30
Dot in front of Aorta

Interarterial course

Dot behind Aorta is Retroaortic course- Benign

Other 2 are Septal and Anterior courses

46
Q

Most common coronary anomaly

A

Is the variation in origin from Aorta

2nd common is LCx arising from RCA

47
Q

In RAO view RCA looks like ……And in LAO view it looks like ……,

A

RAO- L shaped

LAO- C shaped

48
Q

How to canulate a slightly anteriorly misplaced RCA

A

LAO view and JR as usual direct to Right side

49
Q

Timing of sheath removal

A

Diagnostic- immediately

Interventions- 4-6 hours when ACT less than 170

50
Q

Compression time required after sheath removal

A

3-4 mts compression/ 1 French

ie for 5 Fr: 3x 5 = 15 mts

Dr Suresh presentation

51
Q

Which IJV is preferred

A

Right side

Thoracic duct on left
Left may be tortuous

52
Q

Depth of IJV from surface

A

Only 1-1.5 cm

53
Q

How to puncture Subclavian

A

Arm abducted
10-15 Trendelenburg
Shoulders mild retraction

54
Q

Orators hands occurs in ……..artery puncture

A

Brachial Artery

Median nerve injury

55
Q

Which is medial SFA or Deep FA

A

SFA is Medial.

SFAm

56
Q

In leg which artery is medial most

A

Posterior tibial

Lateral most- Anterior tibial

Peroneal artery seen between these 2 vessels

57
Q

First coronary angioplasty was in

A

1977 by Gruntzig

58
Q

Arteria lusoria means

A

Rt Subclavian arises as 4th branch from desc Aorta after LSA.

Then it passes 80% posterior to esophagus 15% in b/w esophagus and trachea &5% antr to trachea And reaches Rt side.

Otherwise known as ARSA.Aberrant RSA

Lusoria is from Lusus naturae which means Sports of Nature ( ie congenital anomaly)

59
Q

Rupturing balloon inside the lesion is called

A

Granedoplasty

60
Q

WIfI classification is for

A

Lower extremity PAD-ESC2017

Wound
Ischemia
foot INFECTION

61
Q

LAO view spine is towards

A

Left of screen

Right of screen- RAO

Centre- AP view

62
Q

View for LMCA

A

Bifurcation- LAO Caudal

Mid- AP caudal

Ostium-AP caudal

RJM 2017

63
Q

When catheter is kept in LMCA look for

A

Reflux and Ventriculaization

64
Q

First branch of LCx

A

LA Circumflex

65
Q

Upto —% of ACS is MINOCA

A

14%

ESC 2017

66
Q

Coronary Ectasia definition

A

Dilatation of atleast 1.5 Times adjacent segment

Many times used interchangeably with Coronary Aneurysm

Markis classification: Type 1- Diffuse in 2 or more vessels
Type2- Diffuse in 1 and localized in 1
Type 3-Diffuse in 1
Type 4- Localized in 1

67
Q

Causes of coronary ectasia

A

Atherosclerosis, Kawasaki, PAN, Scleroderma,Ehler Danlos ,

PEAKS

50% thought to be atherosclerosis related
30%congenital
Rest- inflammatory or connective tissue disease.

ANCA related vasculitis, Syphilitic aortitis

68
Q

Use of nitrates in coronary ectasia

A

May exacerbate Coronary ischemia

69
Q

If MPI shows defect more than……consider PCI

A

10%

Internet

70
Q

First per cutaneous Coronary intervention was done by ……..in ……

A

Andreas Gruntzig 1977

71
Q

The clock for STEMI PCI starts at

A

ECG diagnosis of STEMI-
defined as FMC - first Med contact

Door to Balloon is no longer useful-ESC 2017

72
Q

Time delay to reperfusion has reduced from …..mts in 2012 to …..mts in 2017
ESC 2017

A

30 mts to 10 mts

73
Q

Deferred stenting is

A

Opening the Artery and waiting for 48 hours to implant stent

74
Q

Duration of DAPT in PCI in stable CAD

A

1-6 months depending on bleeding risk

ESC 2017

In ACS- 12 months. 6 If bleeding risk high

75
Q

DAPT after CABG in stable CAD

A

Insufficient data to recommend

ESC 2017

76
Q

Obesity paradox is

A

Elevated BMI-is a risk factor for CAD But Obese and Overweight pts have better outcomes after PCI compared to Normal wt pts

77
Q

In 2013 of the 10 million patients who underwent Cath———% were underweight; ———% were obese

A

0.4%

20%(8% morbidly Obese)

78
Q

Studies supporting complete revasc in STEMI

A

PRAMI, CvLPRIT.

ESC 2017

79
Q

CABG vs PCI

A

No difference in Cardiovascular Mortality or MI

Revasc more with PCI

80
Q

2017 SNTAX II Trial compared

A

450 pts with TVD with PCI with SYNTAX I pts who underwent PCI with first gen stents

81
Q

Scoring system to predict risk of out of Hospital bleeding with DAPT after PCI

A

PRECISE -DAPT

82
Q

Difference between SYNTAX score I &II

A

Unlike the Anatomical Syntax Score SYNTAX SCORE II uses both anatomical and clinical characteristics

83
Q

Study which showed no significant difference between DES and BMS in SVG graft

A

2017 DIVA trial

Previous 4 studies: 3 showed DES superior-ISAR-DES; BASKET-SAVAGE; SOS

1 study: RRISC- higher events with DES

None of these were blinded, used 1st gen DES,And low use of emboli protection unlike the DIVA

84
Q

The 2017 studies which showed that iFR( instantaneous wave free ratio) is a better alternative to FFR

A

2017 DEFINE- FLAIR

and

2017 SWEEDHEART trial

With I FR PTCA and ACE were loss

Cardio (36 decks)

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