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R9 > Chapter 61 - Endovascular therapeutic techniques > Flashcards

Chapter 61 - Endovascular therapeutic techniques Flashcards

(64 cards)

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1
Q

Single-operator exchange system balloon

A

Monorail Rapid exchange wire exits from side hole 20-25 cm proximal to balloon

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2
Q

Pro and con of single-operator exchange system

A

1) less pushability 2) lower profile 3) single operator 4) cannot exchange wire with it

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3
Q

material of POBA

A

plastic polymer usually

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4
Q

Compliance definition

A

degree of expansive ability of the balloon

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5
Q

Nominal pressure

A

Pressure at which balloon expands to determined diameter and length

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6
Q

Rated burst pressure define

A

< 1% of test balloons will burst beyond this point

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7
Q

Mean burst pressure

A

when 50% balloons will rupture

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8
Q

Compliant balloon material

A

polyolefin copolymer polyethylene

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9
Q

Compliant balloon pro and con

A

1) better trackability 2) single balloon can be used for different sizes 3) doggie bone effect that can damage nearby vessel segments 4) provides less damage overall

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10
Q

Non-complaint balloon pro and con

A

= high pressure or low compliance balloons 1) improved radial force 2) maintain design and shape under high pressure 3) higher burst pressure

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11
Q

Non-compliant balloon material

A

Polyethylene terephthalate nylon reinforced polyurethane

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12
Q

Trackability pushability crossability definition

A

Trackability = over wire pushability = transmit force along length to lesion crossability = ability to cross stenotic lesion

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13
Q

Uses of cutting balloons

A

1) short lesions 2) venous graft stenosis 3) bifurcation stenosis 4) no stenting zone 5) in-stent restenosis 6) HD AVF lesions 7) fem pop lesions

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14
Q

Cryoplasty

A

liquid NO to generate -10C for balloon plasty no evidence

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15
Q

LEVANT 1 trial

A

1) single blinded Lutonix DCB study for fempop 2) 101 patients 3) Rutherford class 2-5 4) primary = angiographic late lumen loss 6 months 1) primary patency 72 vs 49% 6 months 2) primary patency 67 vs 55% at 12 months based on freedom from TLR, angiographic restenosis and PSVR > 2.5

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16
Q

Lutonix DCB drugs

A

paclitaxel 2 mcg/mm2

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17
Q

LEVANT 2

A

1) single blinded RCT 2) lutonix vs PTA 3) 476 patients 4) primary patency 65.2 vs 52.6%

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18
Q

Who made the first stent

A

Charles stent - british dentist for dental molds

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19
Q

First PTA done by

A

Charles Dotter 1964

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20
Q

First balloon-expandign stent made by

A

Palmaz 1985

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21
Q

Current iliac stents - table

A

TABLE 61.1

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22
Q

Current SFA stents - table

A

TABLE 61.1

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23
Q

Material of balloon-expandings tents

A

1) stainless steel 2) cobalt-chromium

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24
Q

Benefit of cobalt chromium over stainless steel

A

1) Greater radial force 2) lower crossing profile 3) enhanced flexibility

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25
Material of self-expanding stent
Nitinol nickel titanium alloy
26
Unique feature of the wallstent
Can be repositioned and resheathed
27
Unique feature of the misago (terumo) stent
not overthe wire
28
Pro and con of open cell confirgurationg stent
1) flexible 2) suscepitible to deformation 3) can bend 4) prone to plaque protrusion through strut 5) better trackability in tortuous segments
29
Approval of use for the Advanta V12
tracheobronchial strictures PTFE encased stainless steel
30
Jostent
Abbott 0.014 system two stainless steel stents on PTFE bail out only
31
VIPER trial
Test Viabahn in long SFA occlusion single arm primary patency 73%
32
VIASTAR trial
Viabahn in RCT for SFA lesion primary patency 63.1 vs 40 for BMS even better for longer lesions
33
Viabahn Flair Vluency indication and design
Viabahn - vascular; nitinol encased in PTFE Flair - nitinol and PTFE, use in HD for AV graft anast stenosis Fluency - biliary application; luminexx (nitinol) in PTFE; stent flairs at the last 2mm
34
DES types and evidence
SMART stent (sirolimus; cordis) - SIROCCO I and II trials : no difference in restenosis Dynalink stent (Abbott; everolimus) - STRIDES trial : no difference Zilver PTX (Cook; paclitaxel) - trial = improved patency up to 5 years Eluvia (Boston; paclitaxel based on innova stent) = IMPERIAL trial non inferior
35
Multilayer flow modulator
1) exclude aneurysms 2) 3 dimentional braided tube with multilayer wire and no covering prosthesis 3) Cardiatis MFM 4) patency 87%; aneurysm thrombosis 93%
36
Bioabsorbable stents key points
1) Igaki-Tamai (poly-L lactic acid) in coronary: promising 2) Biotronik (alloy with magnesium and others) 3) INSIGHT trial to test biotronik - no benefit over POBA
37
SilverHawk/TurboHawk
Directional Arthrectomy device cutting blade rotate 8000 rpm DEFINITIVE Ca++ study: good single arm efficacy and safety profile
38
Pathway jetstream
Rotational atherectomy drill with fluid infusion and aspiration port for debris PATHWAY trial - good success without serious events
39
Diamondback 360
Orbital atherectomy system diamond-coated crown that orbits to break debris CONFIRM registry - benefit
40
CVX300 Excimer
Laser arthrectomy device 308 nm wavelength
41
Thromboembolectomy technologies
1) Fogarty balloon 2) Aspiration: Export, PriorityOne, Pronto 3) Rheolytic: Angiojet with vacuum (PEARL registry) 4) rotational: rotarex, trellis infusion catheter (hybrid of thrombolytic and aspiration with balloon trapping of treatment area) 5) Ultrasound enhanced: Ekosonic (SEATTLE II study) - microsonic device with drug delivery 6) others: Solitaire (mechanical thrombectomy with drug delivery) - Trevo stent retriever device - Indigo = vacuum
42
Devices to cross CTO
1) Crosser (Bard): high frequency mechanical recanalization - PATRIOT trial 2) TruePath (Boston): rotating diamond-coated tip 3) Frontrunner XP (Cordis):
43
Re-entry devices
1) Outback (Cordis): needle redirection 2) Pioneer (Volcano): IVUS guided 3) Enteer (Covidien): flat balloon + needle 4) Offfroad (Boston): balloon redirection
44
Pushable coils
0.035 Tornado (Cook) MReye (Cook) 0.018 Tornado (Cook) Diamond (Boston) Trufill (Codman)
45
Detachable coils
0.035 Flipper (Cook) Interlock (Boston) 0.018 GDC (Stryker) Target (Stryker) Interlock (Boston) Cashmere (Codman) Matrix 2 (Boston) Cerecyte (Micrus) Azur (Terumo)
46
Plugs and size range
Amplazer 3-22 mm length 6-18 mm
47
Oversizing of coils
20%
48
Liquid embolic agents
1) Cyanoacrylate (NBCA) 2) fibrin sealant 3) Ethylene vinyl alcohol
49
Exoseal closure device
Cordis Bioabsorbable polyglycolic acid plug absorbs in 60-90 days ECLIPSE trial
50
FISH closure device
Femoral introducer sheath and hemostasis bioabsorbable extrallular matrix of porcine small intestinal submucosa Morris Innovative
51
Mynx duration
30 days before dissolve
52
Prostar XL sizes
8.5 to 10 Fr closure
53
Proglide Fr sizes
5-8Fr with one up to 21 with two
54
typical balloon sizes for different arteries
TABLE 61.3
55
foot angiosome
FIGURE 61.5
56
Grades of dissection after POBA
Grade A: small radiolucent area with lumen of vessel disappearing with passage of contrast materal Grade B: filling defect parallel to lumen of vessel, disappears with passage of contrast Grade C: dissection protruding inside lumen; persists Grade D: spiral shaped defect with delayed run off distally Grade E: persistent luminal filling defect and delayed antegrade flow Grade F: filling defect with total occlusion
57
Stent needed for which grades of dissection after POBA
Grade C to F as long as contrast persists
58
First subintimal angioplasty
Bolia 1989
59
CART technique
Controlled antegrade and retrograde subintimal tracking requires two balloons to crack the plaque
60
When to use a stent in POBA
1) \> 30% resitual stenosis 2) dissection Grade C+ 3) acute occlusion
61
Types of stent fractures
Type 0 = no # Type 1 = single strut # Type 2 = multiple strut # Type 3 = multiple strut # with stent transection Type 4: includes displacement of segments and spiral #
62
Pro and con of balloon-expandable vs self-expanding stents
TABLE 61.4
63
Oversizing self-expanding stents
1-2 mm
64
three steps of coil embolization
Framing (20% oversize) Filling Finishing

R9 (200 decks)

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