test 9 atherectomy

Question 1

Types of Atherectomy Devices

Answer 1

Directional
Rotational
Transluminal extraction

Question 2

Directional Atherectomy

Answer 2

 Percutaneous over-the-wire cutting and retrieval system
 Cutting window placed toward the plaque – balloon inflated pushing plaque into cutting cup – cutter rotates at 2,000 RPM – advanced by physician

Question 3

Rotational Atherectomy

Answer 3

 Elliptical-shapes brass burr coated with 5-10 micron diamond chips
 Rotates at 140- 190,000 RPM
 Saline flush solution infused into the plastic sheath around the drive shaft to minimize frictional heat
 Burr ablates and pulverizes inelastic plaque tissue – 5 micron particles eventually removed by reticuloendothelial system

Question 4

Transluminal Extraction Atherectomy

Answer 4

 Percutaneous over-the-wire cutting and aspiration system
 Head with two stainless steel blades – turn at 750 RPM
 Lactated Ringers solution flushed into area creates particulate slurry that is suctioned back through the catheter

Question 5

Laser problems

Answer 5

 Started with a lot of promise
 Problems
 precise control of laser
 right laser for the type of plaque

Question 6

Transluminal Angiogenesis TMR

Answer 6

 Aka: Transmyocardial revascularization
 Improve blood flow to an area of the heart where surgery or angioplasty may not reach.
 May be option for patients who are not candidates for angioplasty or surgery

Question 7

How is Transluminal Angiogenesis done

Answer 7

 Done through L. Chest incision or midline inscision
 Could be done in conjunction with angioplasty or surgery
 Use a CO2 laser to make 20-50 channels (1 mm in diameter) in each targeted region of
myocardium
 Outer channel closes and inner channel open to inside the heart
 May promote the growth of small new blood vessels