Qualitative and QuantitativeAngiography

Question 1

What is the relationship between lesion morphology and angioplasty outcomes?

Answer 1

The more complex the morphology, the less favorable the initial and later results of coronary angioplasty.

Question 2

List characteristics of type C lesions.

Answer 2

• Diffuse lesions (>20 mm length)
• Excessive tortuosity of proximal segment
• Extremely angulated segments (>90 degrees)
• Total occlusion >3 months duration
• Inability to protect major side branches
• Degenerated vein grafts with friable lesions.

Question 3

What does EES stand for and what is its main feature?

Answer 3

EES stands for Everolimus-Eluting Stents, which use a fluoropolymer to contain and elute everolimus.

Question 4

True or False: EES have the lowest rate of definite stent thrombosis compared to all other stents.

Answer 4

True.

Question 5

What factors are independently associated with higher rates of definite stent thrombosis?

Answer 5

• First-generation DES
• Diabetes mellitus
• Current smoking
• Prior myocardial infarction (MI)
• Presentation with STEMI
• Complex lesion morphology
• Increasing residual stenosis.

Question 6

What are the types of coronary perforation during PCI?

Answer 6

• Type I: Fully contained
• Type II: Limited extravasation
• Type III: Brisk extravasation.

Question 7

What is the significance of the Academic Research Consortium’s temporal categories of stent thrombosis?

Answer 7

To create consensus definitions for DES study endpoints to distinguish differences in the contribution of various pathophysiologic processes.

Question 8

What does the SYNTAX score measure?

Answer 8

The SYNTAX score quantifies the extent and complexity of coronary lesions based on factors like location, lesion length, and presence of thrombus.

Question 9

What is the relationship between SYNTAX scores and revascularization methods?

Answer 9

Patients with scores of ≤32 tend to do as well with PCI as with coronary bypass surgery, while those with high scores are better served by surgery.

Question 10

Fill in the blank: The more complete the revascularization, the ______ the incidence of clinical ischemic events.

Answer 10

lower.

Question 11

What is the TMP grade used for?

Answer 11

The TMP grade characterizes the filling and clearance of the microcirculation, serving as an index of myocardial reperfusion.

Question 12

What are the two methods for determining TMP grade?

Answer 12

• Densitometric method
• Kinetic method.

Question 13

What is the impact of impaired myocardial perfusion on mortality after thrombolytic drug administration?

Answer 13

Impaired myocardial perfusion is associated with higher mortality, independent of flow in the epicardial artery.

Question 14

True or False: The TIMI flow grade is a continuous measure of coronary flow.

Answer 14

False.

Question 15

What are the two methods to estimate reference diameter at the point of maximal stenosis?

Answer 15

• Interpolation method
• Arithmetic average method.

Question 16

What is the residual SYNTAX (rSS) score?

Answer 16

It quantifies the extent and complexity of residual, untreated CAD after revascularization.

Question 17

What is the pattern of late lumen loss after DES implantation?

Answer 17

The distribution is largely skewed to the left, with most patients exhibiting small amounts of late loss.

Question 18

What is the ABSORB scaffold and its unique characteristic?

Answer 18

The ABSORB scaffold is made of polylactate acid, elutes everolimus, and lacks metal, making it invisible on x-ray imaging.

Question 19

Fill in the blank: There is modest agreement between an angiographic core laboratory and ______ in the assessment of TIMI grade 2 flow.

Answer 19

clinical centers.

Question 20

What was observed regarding flow in noninfarct arteries during reperfusion studies with fibrinolytic agents?

Answer 20

Flow in noninfarct arteries was slower than in patients undergoing elective angiography.

Question 21

What is intraprocedural stent thrombosis (IPST)?

Answer 21

A recently described complication of PCI.

Question 22

What is the flow observed in patients undergoing elective angiography compared to those with ACS?

Answer 22

Higher TFC in ACS patients

This observation suggests systemic activation of platelets and secretion of vasoactive substances during ACS.

Question 23

What does IPST stand for?

Answer 23

Intraprocedural stent thrombosis

IPST is a complication of PCI that requires detailed analysis of cine angiograms.

Question 24

What is the definition of IPST?

Answer 24

New or increasing thrombus in a treated lesion

IPST can be transient or permanent.

Question 25

What were the mortality rates at 30 days for patients with IPST versus those without?

Answer 25

12.9% vs. 1.4%

This difference was statistically significant (p < 0.0001).

Question 26

What were the mortality rates at 1 year for patients with IPST versus those without?

Answer 26

12.9% vs. 3.1%

This difference was statistically significant (p < 0.0001).

Question 27

What types of stent thrombosis occurred more frequently in IPST patients at 30 days?

Answer 27

Definite or probable stent thrombosis

Rates were 17.4% in IPST patients vs. 1.8% in non-IPST patients (p < 0.0001).

Question 28

What were the rates of stent thrombosis at 1 year for IPST patients compared to non-IPST patients?

Answer 28

19.9% vs. 2.7%

This difference was statistically significant (p < 0.0001).

Question 29

What was the hazard ratio for 1-year mortality associated with IPST?

Answer 29

3.86

The 95% confidence interval was 1.66 to 9.00, p = 0.002.

Question 30

What are the major adverse ischemic events in patients with IPST compared to those without?

Answer 30

Markedly higher in IPST patients

This includes increased mortality rates and stent thrombosis occurrences.