Revascularization Strategies

Question 1

Revascularization refers to a “____” restoration of blood flow to ____

• Always used in conjunction with best ___ ____

Answer 1

Revascularization refers to a “mechanical” restoration of blood flow to myocardium

• Always used in conjunction with best medical therapy

Question 2

Answer 2

Question 3

this procedure involves the insertion of a stent (scaffolding) within a coronary artery, via radial or femoral artery

Answer 3

percutaneous coronary intervention

Question 4

2 main types of stents in PCI

Answer 4

1. bare metal stent– usually stainless steel or nickel chromium
2. drug-eluting stent– coated with sirolimus or tacrolimus
   - to Prevent sproliferation of endothelium along the stent.

Question 5

PCI involves ____ for visualization

Answer 5

angiography

Question 6

complications of PCI

Answer 6

Question 7

What is done post PCI to prevent thrombosis of the stent

Answer 7

for BMS: dual APAs– ASA plus clopidogrel/ticagrelor for at least one month followed by ASA indefinitely.

for DES: dual APA for at least 12 months followed by ASA indefinitely.

Question 8

what factors cause stent restenosis

Answer 8

•Neointimalproliferation within the stent

•More likely in narrow lesions, longer stents and diabetics •Sub acute process (3-6 months)

•Only prevention is the use of drug eluting stents (RRR 50%, risk to < 5%)

Question 9

outline the CABG procedure

Answer 9

• use another vessel (conduit) to crerate a detour around the blockage and restore blood flow to distal myocardium

Usually done with open-heart procedure, circulatory arrest and heart-lung machine for perfusion •Can be done minimally invasive in certain cases •Can be done on a beating heart (off-pump) in some cases

Question 10

what two arteries are used as conduits in a CABG

Answer 10

Left interior thoracic artery or right ITA

• duable and best suited anterior conduits.
• saphenous vein graft also avaialbe with a 10 year span.

Question 11

why is acute graft failure a concern in CABG

Answer 11

it’s due to thrombosis forming in the graft.

Question 12

what are the indications for CABG over PCI

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Answer 12

1. advanced 3 vessel disease
2. multivessel disease with LV systolic impairment
3. left main coronary artery disease
4. multivessl disease and diabetes
5. PCI not feasible.
6. combination procedure; if you’re gonna do open heart surgery, just do the CABG cause they’ll be open anyway.

Question 13

what are the indications for PCI over CABG

Answer 13

• if possible, do PCI over CABG cause it’s less invasive
• STEMI
• high risk ACS/NSTEMI/UA
• angina that is refractory to medical therapy.-Ex/ person is on palliative care for cancer and keeps having chest pain. Just put in a stent even though your mortality isn’t reduced– its’ more for pain relief.