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Invasive Cardiology Board Review > Peripheral InterventionalProcedures > Flashcards

Peripheral InterventionalProcedures Flashcards

1
Q

What procedure has shown noninferiority to traditional surgical carotid endarterectomy in high-risk populations?

A

Carotid artery stenting

Supported by several registries and the SAPPHIRE trial.

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2
Q

What was the primary endpoint of the SAPPHIRE trial?

A

Composite of death, stroke, and MI within 30 days

Results showed a 39% reduction in this endpoint for stenting.

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3
Q

What were the results regarding 1-year event-free survival in the SAPPHIRE trial?

A

88% for stenting vs. 79% for endarterectomy

Statistically significant with p = 0.048.

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4
Q

What are some criteria for high-risk candidates for carotid artery stenting?

A
  • Age >80 years
  • CHF III to IV
  • EF < 30%
  • Recent MI
  • Unstable angina
  • Severe pulmonary disease
  • Contralateral laryngeal nerve palsy

These criteria were established based on clinical and anatomic considerations.

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5
Q

What did a recent meta-analysis conclude about stenting for symptomatic carotid stenosis in older patients?

A

Should be avoided in patients age ≥70 years

Stenting might be safe for younger patients.

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6
Q

What is the incidence of stroke post carotid artery stenting in high-risk patients?

A

Approaches 3%

Primary mechanism is distal embolization of atheromatous debris.

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7
Q

What complication can occur due to distention of the carotid sinus mechanoreceptors during stenting?

A

Hypotension and bradycardia

Occurs in up to 40% of procedures involving internal carotid lesions.

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8
Q

What was the incidence of MI within 30 days of carotid stenting in the SAPPHIRE trial?

A

1.9%

Significantly lower than after carotid endarterectomy.

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9
Q

What is the compensatory response of cerebral vessels to carotid occlusive disease?

A

Compensatory vasodilation

Aims to maintain adequate blood flow to the brain.

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10
Q

What are symptoms of hyperperfusion following carotid artery intervention?

A
  • Throbbing headache
  • Nausea
  • Vomiting
  • Visual changes
  • Focal motor deficits
  • Seizures

Symptoms can occur due to sudden increase in blood flow to dilated vasculature.

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11
Q

What is the initial test of choice for diagnosing PAD according to AHA Guidelines?

A

Resting ABI

ABI is calculated by dividing the highest dorsalis pedis or posterior tibial pressure by the highest arm pressure.

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12
Q

What is considered an abnormal ABI value indicating PAD?

A

ABI <0.9

Diagnosis is confirmed in symptomatic patients with this ABI.

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13
Q

What medications are FDA-approved for relief of claudication due to PAD?

A
  • Pentoxifylline
  • Cilostazol

Cilostazol is a type III phosphodiesterase inhibitor.

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14
Q

What was the result of cilostazol in a meta-analysis for patients with moderate to severe claudication?

A

Increased maximal walking distances by 50% and pain-free walking distances by 67%

Based on eight randomized trials.

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15
Q

What is the normal range for ABI?

A

1.00 to 1.40

Values above 1.40 suggest a noncompressible artery.

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16
Q

What is the recommendation for patients with claudication symptoms and abnormal ABI?

A

Undergo diagnostic testing for PAD

Patients with risk factors should also be tested.

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17
Q

What are the independent predictors of increased walking distances in exercise rehabilitation for PAD?

A
  • Use of claudication endpoint
  • Program length
  • Mode of exercise

These factors were identified in a meta-analysis of 33 trials.

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18
Q

What is the significance of the Heart Protection Study regarding PAD?

A

Reduction in all-cause mortality by 13% and major vascular events by 24%

Study involved 20,536 patients with CAD, diabetes, or PAD.

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19
Q

What is the complication rate of PTA in the infrapopliteal vascular bed?

A

Not prohibitively high

Clear indications for PTA exist despite potential risks.

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20
Q

What are the lifestyle modifications recommended for patients with PAD?

A
  • Aggressive management of diabetes
  • Cessation of tobacco use

These modifications are essential alongside medical therapy.

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21
Q

What is the risk of limb loss for smokers with claudication symptoms?

A

20% risk of limb loss

Smokers have increased rates of disease progression.

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22
Q

What were the major adverse events reported in the studies?

A

No major adverse events such as death, MI, or limb loss were reported

MI stands for myocardial infarction.

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23
Q

What was the p-value indicating the increase in ABIs after intervention?

A

p = 0.0001

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24
Q

What is the recommended therapy for patients with PAD who smoke?

A

Pharmacologic therapy with varenicline, bupropion, and/or nicotine replacement

Referral to a smoking cessation program is also recommended.

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25
Q

What type of exercise program is recommended for patients with PAD?

A

Supervised exercise programs performed for 30 to 45 minutes three times per week for a minimum of 12 weeks

26
Q

What is the effect of statin medications in patients with PAD?

A

Decrease major adverse cardiovascular and cerebrovascular events (MACCE), mortality, and major amputation or death

27
Q

Which medication has been shown to improve PAD symptoms and increase walking distance?

A

Cilostazol

28
Q

What are the mostly ineffective treatments for claudication?

A

Pentoxifylline, iron chelation with ethylenediaminetetraacetic acid, or B-complex vitamin supplementation

29
Q

What is the primary aim of revascularization in chronic limb ischemia?

A

Decreasing limb pain and improving wound healing

30
Q

What is favored in patients with high surgical risk for revascularization?

A

Endovascular revascularization

31
Q

What percentage of patients experience restenosis after balloon angioplasty within one year?

A

Approximately 60%

32
Q

What was the primary endpoint of the LEVANT 2 trial?

A

Freedom from restenosis or repeat revascularization of the target lesion at 12 months

33
Q

What are the two main causes of renal artery stenosis?

A

Atherosclerotic disease and fibromuscular dysplasia (FMD)

34
Q

What is the characteristic appearance of FMD on angiography?

A

String of beads

35
Q

What is recommended for patients with unilateral renal artery stenosis who have hypertension?

A

Treatment of renal artery stenosis may benefit patients

36
Q

What factors guide the management strategy for asymptomatic aneurysms?

A

Risk of rupture, size of aneurysm, and rate of aneurysm expansion

37
Q

What is the recommended treatment for aneurysms larger than 5.5 cm?

A

Surgical repair

38
Q

What does renal denervation target to address resistant hypertension?

A

The autonomic nervous system, particularly the sympathetic nervous system

39
Q

What was the outcome of the SIMPLICITY HTN-3 trial regarding renal denervation?

A

Renal denervation did not provide better blood pressure control than medical therapy alone

40
Q

What are the common complications associated with renal arteriography?

A

Atheroembolism, renal artery ostial trauma, dissection, and contrast nephrotoxicity

41
Q

What is the technical success rate of percutaneous revascularization in patients with FMD?

A

88.2%

42
Q

What is the combined complication rate for surgical revascularization in FMD?

A

16.9%

43
Q

What is the combined complication rate for patients who underwent surgical revascularization?

A

16.9%

The majority of complications were defined as major (15.4%) with a perioperative mortality of 1.2%

44
Q

What is the hypertension cure rate with surgery?

A

57.5%

This indicates the effectiveness of surgical intervention in treating hypertension.

45
Q

What is the most critical component of a technically successful endovascular AA repair?

A

Preprocedural planning

CT provides the backbone for evaluating patient candidacy.

46
Q

What anatomic criteria must patients fulfill for EVAR?

A

Patients must have:
* Iliofemoral access vessels that allow safe insertion and deployment of the device
* An infrarenal aortic neck of adequate length, limited angulation, and appropriate diameter

47
Q

What was the significant finding of the EVAR-1 trial regarding 30-day mortality?

A

Endovascular repair group had 1.6% mortality compared to 4.7% in surgical group

p = 0.007 indicates statistical significance.

48
Q

What were the long-term follow-up results of the EVAR-1 trial regarding all-cause mortality?

A

Similar all-cause mortality between endovascular and surgical repair groups

Endovascular repair group had higher overall rates of complication.

49
Q

What was the complication rate in the endovascular group of the EVAR-1 trial?

A

17.6/100 person years

Compared to 3.3/100 person years in the surgical group.

50
Q

What do the results of the DREAM trial indicate about endovascular vs. open surgical repair?

A

Similar long-term cumulative survival rates

A significant reduction in aneurysm-related mortality was noted in the endovascular group.

51
Q

What is the five-year and nine-year rupture-free survival rate observed after EVAR?

A

> 97% for 5-year and >94% for 9-year

Indicates the long-term effectiveness of EVAR.

52
Q

What are independent risk factors for AA rupture?

A
  • COPD
  • Hypertension
  • Female gender
  • Smoking
  • Symptoms like abdominal tenderness or back pain
  • Expansion >0.6 cm in 1 year
53
Q

What is the most common serious perioperative complication of EVAR?

A

Cardiac complications

These complications are also the most common cause of late death.

54
Q

What is subclavian steal syndrome?

A

A group of symptoms due to vertebrobasilar insufficiency from proximal subclavian stenosis

Symptoms can include upper extremity claudication, paresthesia, and visual symptoms.

55
Q

What are the indications for revascularization of the subclavian artery?

A
  • Symptomatic steal syndrome
  • Disabling upper extremity weakness
  • Vertebrobasilar insufficiency
  • Preservation of flow to in situ internal mammary grafts
  • Evidence of embolic phenomenon
56
Q

What is the most efficient and precise strategy to diagnose and treat subclavian steal syndrome?

A

Angiography

While ultrasound and MRA can help, angiography is preferred.

57
Q

What is the most commonly seen variation of right-sided aortic arch?

A

Left carotid as the first branch and left subclavian as the last branch

Understanding this requires familiarity with embryology.

58
Q

What characterizes Takayasu’s arteritis?

A

Inflammation of the aorta and its main branches

It primarily affects females, is more common in Asians, and has a mean age presentation of 25 years.

59
Q

What were the most common presenting symptoms in patients with Takayasu’s arteritis?

A
  • Arm claudication
  • Light-headedness
  • Visual changes
  • Constitutional complaints (weight loss, fever)
60
Q

What is the treatment for Takayasu’s arteritis?

A

Oral steroids at 1 mg/kg for up to 3 months; cytotoxic agents if steroids can’t be weaned

Surgical treatment is indicated for refractory hypertension or severe stenosis.

61
Q

What branches does the celiac artery divide into?

A
  • Left gastric artery
  • Hepatic artery
  • Splenic artery
62
Q

What is the function of the left gastric artery?

A

Provides blood flow to portions of the esophagus and the cardiac portion of the stomach

It anastomoses with the right gastric artery.

Invasive Cardiology Board Review (42 decks)

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