Percutaneous Coronary Intervention Flashcards
Where is arterial access obtained by generally?
Femoral and Radial artery
What arterial access is becoming increasingly preferred?
Radial Access
What are the advantages of radial access rather than femoral?
-Infrequent access site bleeding
-Earlier ambulation
-improved patient satisfaction
-Lower cost
-Reduced Mortality
What are the disadvantages of radial access rather than femoral?
Learning Curve
Radial Artery occlusion
Inability to use larger catheters
Patients with renal access needs hemodynamic support
After visual of the target lesion via arteriography, what is next?
Coronary guide wire is advances across the lesion and positioned in the distal vessel
Once the coronary guide wire is positioned in the distal vessel, what happens next?
A small double lumen catheter with a distal balloon is passed over the guide wire and positioned at the lesion
Once the double lumen catheter is placed at the site what do they do next?
Pre dilation with the balloon to open the obstruction.
Once the balloon catheter has been dilated, what is done next?
Unemployed stent is mounted on a second balloon catheter and is passed over the guide wire to the lesion, where the balloon is inflated and the stent is deployed.
When the stent is placed, what is done next?
A high pressure balloon catheter is then used to fully expand the stent.
Following PCI from the femoral approach, what should occur?
The femoral sheath is removed once activated clotting time has returned to baseline.
When can radial sheaths be removed after PCI?
Immediately after the procedure while patient is still anti coagulated.
What do all patients receive when they undergo PCI?
Aspirin
Full anticoagulation
Heparin or Bivalirudin
How long does it take for DESs to become completely covered in endothelium
Months
What has been a major concern of DESs
Late stent thrombosis (ST)
What is the current guidelines for DESs for stable coronary indications?
DAPT for a minimum of 6 months (aspirin plus clopidogrel)
What is the current guidelines for DESs for ACS?
1 year of DAPT (aspirin plus prasugrel/ticagrelor)
When do you need a longer duration of DAPT?
High risk patients
Myocardial infarction
First generation stents (paclitaxel eluting)
What is the procedural success rate in patients with proper patient selection and experienced operators?
> 95%
What does the AHA recommend that PCI be performed?
Institutions that do over 400 PCI procedures a year
Operators who perform over 75 procedures a year
What do DESs coated with?
Thin polymer carrying immunosuppressive or antiproliferative drugs that are released over time.
What do DESs prevent?
neointimal hyperplasia
restenosis rates
what is the percentage for repeat revascularization at 6 months for BMSs
15 to 20%
What is the percentage of the repeat revascularization at 6 months for DESs
5 to 7%
What is the most frequent complication with PCI?
Arterial access site
bleeding
hematomas
