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1
Q

One yr Stent thrombosis rate with new generation DES

A

<1%

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2
Q

One yr restenosis rate with new generation DES

A

<5%

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3
Q

Rates of very late Stent thrombosis beyond 1 yr

A

0.1-0.2% per year

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4
Q

Rates of very late stent restenosis beyond one year

A

1-2% per year

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5
Q

Theoretical advantage of BRS (bio reabsorbable scaffold ) is

A

Restoring vessel physiology

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6
Q

Length of catheters, normal GW, PTCA wire, Balloon, microcatheter

A

100;145;190; 145; 150

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7
Q

3 types of newer stents

A
  1. Bioreabsorbable polymer DES
  2. Polymer free DES
  3. Bioreabsorbable DES or scaffolds
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8
Q

Stent thrombosis types

A
  1. Late-1 month to 12 months
  2. Early-Less than 1 month
  3. Very late- More than 12 months

ie 2nd month is Late
2nd Year is Very Late

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9
Q

SB occlusion is higher if the angle with main branch is less than

A

45 degrees

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10
Q

SB of —-size should be preserved

A

More than 2mm

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11
Q

Most frequently used bifurcation strategy

A

Provisional T stenting

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12
Q

Strategy for side branch <2.5 mm is

A

Balloon Angio if required to KIO- Keep it open

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13
Q

When to consider elective stenting of SB

A

Size 2.5 mm or more
Lesion more than 3 mm from ostia

Consider in these cases

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14
Q

The inner diameter of 6F,7F& 8F guides are

A

.07 inch, .08 inch and .09 inch respectively

ie one plus

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15
Q

2 stent technique can be done with —–guide

A

7F

One stent and a balloon can be accomadated in a 6 F.( monorail)

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16
Q

In bifurcation which branch to wire first

A

SB as it is usually the difficult one

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17
Q

The main technical concern in 2 stent bifurcation tech is

A

Preventing wire wrapping

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18
Q

Maneuver for removing Amplatz catheter

A

Push and Turn maneuver

NEVER pull back like a Judkins. Will dissect infr wall of Vessel

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19
Q

What is angle Theta in coronary intervention

A

Angle between the JL and opposite wall of Aorta .The inferior angle.

If angle Theta is 90 degree the Cos Theta is 0 So force of dislodgement is less. So greater the angle better the support.
That’s why in TRI JL3.5 gives better support than JL 4 . As angle Theta will be more

Tricks and Tips

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20
Q

Persistent thrombus in PCI. What to do

A

If wire is in lumen,
A. For large thrombus- Thromectomy using Angiojet device
B. For smaller and distal thrombus-Aspiration
If still thrombus…
C. Can give intracoronary rTPA 5mg ever 5 mts to a max dose of 50 mg ? some say 25 mg max
Then if coronary is clean Heparin infusion for 24 hrs and maintain ACT above 200
If coronary is not clean (thrombus or distal flow suboptimal)Intracoronary bolus of 2b3a followed by infusion for IV 12 hours

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21
Q

Preferred bifurcation tech when LMCA is short or in Emergency

A

V stenting

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22
Q

Coulette technique is indicated inLM when

A

LM/LCx angle is less than 60

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23
Q

Treatment of kink site stenosis of LIMA in CABG

A

Usually resolves spontaneously.

To treat only if ischemic sequelae

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24
Q

Order and site of putting grafts in CABG

A

RCA grafts -attached to Rt side of Aorta. So use LAO view

Left sided grafts- LAD, Diagonal, LCx in that order. LAD closest to Aortic valve. From ANTERIOR aspect of Aorta. So use RAO view

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25
Diameter of normal adult LIMA
1.9-2.6 cm While SVG is 3.1-8.5 cm
26
Gold standard for calcification lesions
Rotational atherectomy
27
Stent grafts may shorten upto____% on inflation
25%
28
Burr to artery ratio when rotablation done prior to stenting
0.6-0.7/1
29
Intermediary coronary stenosis means
B/w 40-80%
30
How to untwist a twisted guide
1. If possible push it into a larger area like Aorta from a smaller branch 2. Gently push an .035 wire through the twisted area
31
How to change a guide with wire across a lesion
1. Extend the wire 2. While injecting CONTRAST from a syringe; pull Guide out retaining PTCA wire. Then insert the new guide through 0.035 wire keeping PTCA wire in position. Then finally reinsert the Guide though a balloon catheter
32
D2B time in PPCI
Less than 90 mts Further reduction may not result in better outcomes Now D2B is not preferred. FMC -first medical contact (ie time at which someone makes the ECG diagnosis) is used 2017
33
The skin crease in thigh is distal to CFA bifurcation in ........%
70%. .CFA bifurcation was on an average 6mm above skin crease. Esp obese
34
Skin nick site for FA puncture flouroscopically
Inferior border of femoral head Puncture at center of femoral head
35
Heparin dose in TRA Angio
50 units/kg
36
NTG and Diltiazem inTRA
N-100-200 mcg D- 2-5 mg
37
Radial artery occlusion rate in TRA
5% Higher rates with routine Doppler
38
Complications with ulnar access
Nerve injury more likely Don't do after failed ipsilateral radial attempt
39
Site of brachial access
2-3 cm above elbow crease | Medial aspect of cubital fossa
40
Femoral vein insertion site
2cm below Ing ligament, not the crease
41
Preferred arm Position in Subclavian access
Abducted
42
When RCA or LCA originates from the opposite Sinus the 4 routes taken are
1. Septal - Most common 2. Retroaortic 3. Anterior 4. Interarterial- Least common and most serious one
43
How to identify septal pathway of an anomalous course of coronary
RAO view Fish hook picture Because LM goes down to septum and then comes up in the epicardium LCx then would curve backwards and form the eye with LCx as upper border
44
View for differentiating different anomalous coronary courses
RAO 30
45
Most dangerous course of anomalous LMCA is seen in CAG as
RAO 30 Dot in front of Aorta Interarterial course Dot behind Aorta is Retroaortic course- Benign Other 2 are Septal and Anterior courses
46
Most common coronary anomaly
Is the variation in origin from Aorta 2nd common is LCx arising from RCA
47
In RAO view RCA looks like ......And in LAO view it looks like ......,
RAO- L shaped LAO- C shaped
48
How to canulate a slightly anteriorly misplaced RCA
LAO view and JR as usual direct to Right side
49
Timing of sheath removal
Diagnostic- immediately Interventions- 4-6 hours when ACT less than 170
50
Compression time required after sheath removal
3-4 mts compression/ 1 French ie for 5 Fr: 3x 5 = 15 mts Dr Suresh presentation
51
Which IJV is preferred
Right side Thoracic duct on left Left may be tortuous
52
Depth of IJV from surface
Only 1-1.5 cm
53
How to puncture Subclavian
Arm abducted 10-15 Trendelenburg Shoulders mild retraction
54
Orators hands occurs in ........artery puncture
Brachial Artery Median nerve injury
55
Which is medial SFA or Deep FA
SFA is Medial. SFAm
56
In leg which artery is medial most
Posterior tibial Lateral most- Anterior tibial Peroneal artery seen between these 2 vessels
57
First coronary angioplasty was in
1977 by Gruntzig
58
Arteria lusoria means
Rt Subclavian arises as 4th branch from desc Aorta after LSA. Then it passes 80% posterior to esophagus 15% in b/w esophagus and trachea &5% antr to trachea And reaches Rt side. Otherwise known as ARSA.Aberrant RSA Lusoria is from Lusus naturae which means Sports of Nature ( ie congenital anomaly)
59
Rupturing balloon inside the lesion is called
Granedoplasty
60
WIfI classification is for
Lower extremity PAD-ESC2017 Wound Ischemia foot INFECTION
61
LAO view spine is towards
Left of screen Right of screen- RAO Centre- AP view
62
View for LMCA
Bifurcation- LAO Caudal Mid- AP caudal Ostium-AP caudal RJM 2017
63
When catheter is kept in LMCA look for
Reflux and Ventriculaization
64
First branch of LCx
LA Circumflex
65
Upto —% of ACS is MINOCA
14% ESC 2017
66
Coronary Ectasia definition
Dilatation of atleast 1.5 Times adjacent segment Many times used interchangeably with Coronary Aneurysm Markis classification: Type 1- Diffuse in 2 or more vessels Type2- Diffuse in 1 and localized in 1 Type 3-Diffuse in 1 Type 4- Localized in 1
67
Causes of coronary ectasia
Atherosclerosis, Kawasaki, PAN, Scleroderma,Ehler Danlos , PEAKS 50% thought to be atherosclerosis related 30%congenital Rest- inflammatory or connective tissue disease. ANCA related vasculitis, Syphilitic aortitis
68
Use of nitrates in coronary ectasia
May exacerbate Coronary ischemia
69
If MPI shows defect more than......consider PCI
10% Internet
70
First per cutaneous Coronary intervention was done by ........in ......
Andreas Gruntzig 1977
71
The clock for STEMI PCI starts at
ECG diagnosis of STEMI- defined as FMC - first Med contact Door to Balloon is no longer useful-ESC 2017
72
Time delay to reperfusion has reduced from .....mts in 2012 to .....mts in 2017 ESC 2017
30 mts to 10 mts
73
Deferred stenting is
Opening the Artery and waiting for 48 hours to implant stent
74
Duration of DAPT in PCI in stable CAD
1-6 months depending on bleeding risk ESC 2017 In ACS- 12 months. 6 If bleeding risk high
75
DAPT after CABG in stable CAD
Insufficient data to recommend ESC 2017
76
Obesity paradox is
Elevated BMI-is a risk factor for CAD But Obese and Overweight pts have better outcomes after PCI compared to Normal wt pts
77
In 2013 of the 10 million patients who underwent Cath———% were underweight; ———% were obese
0.4% 20%(8% morbidly Obese)
78
Studies supporting complete revasc in STEMI
PRAMI, CvLPRIT. ESC 2017
79
CABG vs PCI
No difference in Cardiovascular Mortality or MI Revasc more with PCI
80
2017 SNTAX II Trial compared
450 pts with TVD with PCI with SYNTAX I pts who underwent PCI with first gen stents
81
Scoring system to predict risk of out of Hospital bleeding with DAPT after PCI
PRECISE -DAPT
82
Difference between SYNTAX score I &II
Unlike the Anatomical Syntax Score SYNTAX SCORE II uses both anatomical and clinical characteristics
83
Study which showed no significant difference between DES and BMS in SVG graft
2017 DIVA trial Previous 4 studies: 3 showed DES superior-ISAR-DES; BASKET-SAVAGE; SOS 1 study: RRISC- higher events with DES None of these were blinded, used 1st gen DES,And low use of emboli protection unlike the DIVA
84
The 2017 studies which showed that iFR( instantaneous wave free ratio) is a better alternative to FFR
2017 DEFINE- FLAIR and 2017 SWEEDHEART trial With I FR PTCA and ACE were loss

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