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Perf Tech Final !!!!! > Alternative Approaches > Flashcards

Alternative Approaches Flashcards

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1
Q

Prevalence of Heart Disease

in the U.S. (2006) ?%

A

81,100,000 (>30% of the population) has some form of heart disease

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2
Q

Most common types of Heart Disease??

A 
Hypertension (74,500,000) (systolic >140; diastolic >90)
Age 60 or older (38,100,000)
Coronary heart disease (17,600,000)
angina pectoris (10,200,000)
myocardial infarction (8,500,000)
Stroke (6,400,000)
Congestive heart failure (5,800,000)
Congenital cardiovascular defects (650,000 
–1,300,000)
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3
Q

What age has the most prevelance of CVD?

A

80+ (83/87%)

60-79 (70% ish)

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4
Q

First two most prevalent mortality causes in the US? (2006 -2010)

A
  1. Cardiovascular disease
  2. Cancer
  3. Accidents (M) Chronic lower Resp Disease (F)
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5
Q

Elimination of all forms of cardiovascular disease would increase average life span by what??
Average: 77.7 years - 2002

A

by 7 years

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6
Q

Elimination of all forms of cancer would increase the average life span by what?
Average: 77.7 years - 2002

A

by 3 years

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7
Q

Top 3 CV procedures in 2002?

A

Cath lab
angioplasty
total surgical

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8
Q

1929: Dr. Werner Forssmann

A

–First documented human cardiac catheterization

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9
Q

1941: Cournand and Richards

A

Employ cardiac catheter as diagnostic tool for the first time

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10
Q

1956: Forssmann, Cournand and Richards

A

Share the Nobel Prize

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11
Q

1958: Dr. Mason Sones

A

Developed the concept of the diagnostic coronary angiogram

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12
Q

1964: Dr. Charles Dotter

A

Introduced the concept of transluminal angioplasty

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13
Q

1967: Dr. Rene Favalo

A

Performs first saphenous vein graft surgery in Cleveland

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14
Q

1974: Andreas Gruentzigro

A

Performs first peripheral human balloon angioplasty

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15
Q

1976: Andreas Gruentzig

A

Presents results of animal studies of coronary angioplasty at the American Heart Association meeting

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16
Q

1977: Gruentzig, Myler and Hanna

A

First intraoperative human coronary balloon angioplasty (San Francisco)

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17
Q

1977: Andreas Gruentzig

A

First cath lab PTCA on awake patient (Zurich)

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18
Q

1978: Myler and Stertzer

A

First PTCA cases performed in America (San Francisco/New York)

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19
Q

1982

A

Over-the-wire coaxial balloon systems introduced –steerable guide wires developed

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20
Q

1986:

A

Coronary atherectomy devices introduced

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21
Q

1986: Puel and Sigwart

A

-First use of stents in humans reported

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22
Q

1987-1994:

A

number of interventional devices invented, perfected and approved (lasers, rotational atherectomy devices, intravascular ultrasound, stents)

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23
Q

1997:

A

Over one million angioplasties performed world-wide –most common medical intervention in world

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24
Q

2001

A

Almost two million angioplasties

performed world-wide

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25
Percutaneous Transluminal Coronary Angioplasty (PTCA)
balloon advanced to level of blockage –balloon inflated –plaque pushed back against vessel wall / small cracks created with the plaque (plaque fissures) / artery stretched
26
Stenting
balloon advanced to level of blockage –balloon inflated to deploy the stent bare-metal versus drug-eluting stents
27
Criteria for Angioplasty? (5)
- Balloon can be passed through the blockage - Blockage can be reached by the catheter - Blocked vessel is not the left main original use for one or two vessel disease –now being applied to multi-vessel cases - Patient is not in heart failure - Patient is having a heart attack (if treatment can begin within two to six hours of onset)
28
Advantages of Angioplasty ?
- Less invasive than bypass surgery - Relatively low risk - Relatively low cost - Local anesthesia versus general - Percutaneous incision - Patient able to return to normal activity shortly after procedure (most go home after 24hrs –return to normal activity within one week)
29
How may stents be prevented from causing clot formation?
most patients placed on antiplatelet therapy including aspirin and clopidogrel ticlopidine (Plavix /Ticlid) must continue therapy for at least one year –additional benefit has been shown if therapy started one to three days before procedure
30
Risks/Complications of Angioplasty ? (LOTS)
``` Bleeding from the insertion artery Damage to the insertion artery by the catheter Damage to the coronary artery by the catheter Restenosis (long term) Sudden vessel closure 5% of patients with PTCA only Stents may cause clot formation Infection Allergic reaction to dye Myocardial infarction Need for emergency bypass surgery 2 to 5 percent for PTCA / 0.5% w/ stenting Stroke Death ```
31
Restenosis Rates -- PTCA ?
PTCA –10% to 40% during the first six months
32
Restenosis Rates of Bare Metal Stent?
Bare-metal stent –30% to 50% during first six months
33
Restenosis Rate of Drug Eluting Stent?
Drug eluting stent –7% to 15% during first six months
34
Pt Restrictions Following Angioplasty (3)
-Refrain from lifting heavy objects, engaging in strenuous exercise or sexual activity for at least 24 hrs -Increased fluid intake first 24 hrs –help remove dye -Most pts will receive some sort of anti-platelet therapy
35
75% of the stent insertions follow plaque treatment with what?
PTCA or atherectomy
36
Stent Sizing???
- -stent must cover the complete length of the blockage | - -stent must be fully expanded so there are no gaps btwn the surface of the plaque and the stent
37
Where is it difficult to stent?
bifurcations of two vessels
38
When is stent covered with layer of endothelial cells?
Within four to six weeks the stent is covered with a thin layer
39
Drug Eluting Stent is what?
Bare-metal stent coated with slow-to-moderate-release drug formulation that is embedded in a polymer
40
What is restenosis ?
restenosis not a recurrence of CAD –actually bodies response to the “controlled injury” of angioplasty restenosis characterized by growth of smooth muscle cells (i.e. scar formation)
41
Boston Scientific–
Taxus paclitaxel- eluting stent chemotherapeutic drug
42
Johnson and Johnson / Cordis =
Cypher sirolimus-eluting stent | immunosuppressive agent
43
Medtronic & Guidant have what kind of stents??
drug-eluting stents in the early stages of clinical trials (2006 at the earliest)
44
Drug Eluting stents have the biggest action on what type of patients?
Biggest impact may be on patients with diabetes
45
Atherectomy
Currently used as adjunct to PTCA and stent placement Actually removed plaque material
46
Atherectomy may work best in what??
``` COMPLEX LESIONS heavily calcified / fibrotic / undilatable lesions ostial & branch-ostial lesions chronic total occlusions in-stent restenosis ```
47
Types of Atherectomy Devices?
Directional Rotational Transluminal extraction
48
Directional Atherectomy | (RPM?)
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
49
Rotational Atherectomy?
Elliptical-shapes brass burr coated with 5-10 micron diamond chips 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
50
Rotational Atherectomy speed?
Rotates at 140-190,000 RPM
51
Rotational Atherectomy burr ablates what size particles and what happens to them?
Burr ablates and pulverizes inelastic plaque tissue –5 micron particles eventually removed by reticuloendothelial system
52
Transluminal Extraction Atherectomy | what? RPM?
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
53
Transluminal Extraction Atherectomy -- flushing solution?
Lactated Ringers solution flushed into area creates particulate slurry that is suctioned back through the catheter
54
Plaque Laser Problems?
precise control of laser | right laser for the type of plaque
55
Transluminal Angiogenesis Aka:
Transmyocardial revascularization
56
Transluminal Angiogenesis does what?
Improve blood flow to an area of the heart where surgery or angioplasty may not reach Use a CO2 laser to make 20-40 mm channels in myocardium Outer channel closes and inner channel open to inside the heart May promote the growth of small new blood vessels
57
Transluminal Angiogenesis option for who?
May be option for patients who are not candidates for | angioplasty or surgery
58
Transluminal Angiogenesis done how? (incision? with?)
Done through L. Chest incision or midline inscision | Could be done in conjunction with angioplasty or surgery
59
CABG without bypass? (2)
MIDCAB | OPCAB
60
CABG with assisted perfusion?
PADCAB (perfusion assisted direct coronary artery | bypass)
61
Minimal CABG with cardiopulmonary bypass access?
Portal-access
62
OPCAB devices to hold heart/ chest open?
Genzyme Guident (Ultima II) Octopus
63
Robotic type?
DaVinci
64
Percutaneous Valves Mitral valves? Aortic Valves?
MV -- E Clip | AV -- Edwards, Sorin
65
Aortic Valve Types? (3)
Edwards SAPIEN Medtronic CoreValve Sorin Perceval (investigational)
66
Aortic Valve Insertion ways ? (4)
Tranfemoral Transapical Subclavian Direct Aortic

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