SCAI Chapter 14 PCI equipment guides Flashcards

Question

Are 2 monorail balloons compatible with 5 FR guiding catheters?

Answer 1

JL4, AL-1, EBU 3.75, XB 3.5, VL4

Answer 2

JR4, AL-1, AR-1, AR-mod, HS or hockey stick

Answer 3

JL4.5, JL5, AL ≥ 2, EBU/XB ≥4, VL 5 or Voda left

Answer 4

JR ≥ 5, AL ≥ 2

Answer 5

JL3.0-3.5, AL-0.75, EBU 3.5, XB 3, VL 3

Answer 6

JR 3, AL 0.75

Answer 7

AL, amplatz left; AR, amplatz right; EBU, extra back-up; HS, hockey stick; JL, judkins left; JR, judkins right; VL, voda left; XB, xtra back up.

Answer 8

Similar shapes will work, but the curve must be decreased, often approximately ½ size to achieve coaxial engagement.

Answer 9

JL3.5, AL-1, EBU 3.0-3.5, XB 3.0, VL3, IL 4.0

Answer 10

JR4, AL-1, AR-1, AR-mod, Ikari R or Ikari L 4.0, HS

Answer 11

JL ≥ 4, AL ≥ 2, EBU ≥ 3.75, XB ≥ 3.5, XLV ≥ 4

Answer 12

JR ≥ 5, AL ≥ 2

Answer 13

JL3.0-3.5, AL-0.75, EBU 3.0, XB 3, XLV 3

Answer 14

JR 3, AL 0.75, AR-1, AR mod

Answer 15

Comparative backup force of various French guiding catheters with automated balloon advancement in an ex vivo transradial dry model.

Answer 16

Engagement with a JL4 guide offers less backup support than deep engagement using the JL4 or an extra-backup left guide.

Answer 17

An Ikari left (IL4) and IL4 with power position using deep engagement offered the highest degree of backup support.

Answer 18

Cosine of zero equals one and cosine of 90 equals zero. So when theta angle is close to 90, maximum force is quite high ( close to indefinite ) and hence there is maximum support. However, when the angle is very small, then lambda equals maximum force, and since lambda is a static friction, then the system will collapse

Answer 19

Passive support is derived from material stiffness, guide curve coaxial alignment, contralateral aortic wall contact, catheter size, and angle of contact.

Answer 20

Larger catheters are inherently stiffer and offer greater support than smaller guiding catheters.

Answer 21

Active support is achieved by guide manipulation to conform to the aortic root or deep engagement of the catheter.

Answer 22

Caveats include vessel size and proximal disease, as deep intubation may cause pressure dampening, flow obstruction, and/or vessel dissection.

Answer 23

Guide catheter size impacts the type and amount of equipment that can be delivered, with larger catheters improving backup force.

Answer 24

Benefits can be offset by higher contrast volume utilization and higher rates of vascular complications.

Answer 25

Body habitus and access route radial versus femoral, limit guiding catheter size, especially in radial access.

Answer 26

Sheathless guiding catheters allow for a step-up in guide size to accommodate access site (exam 8 French for radial access) but compromise torque control and may be more prone to kinking.

Answer 27

They engage vessels with ostial vessel disease that normally causes pressure dampening , preventing excessive pressurization of the coronary vessel and reduce the chance for hydraulic vessel dissection, and enabling reliable aortic pressure monitoring. In summary, they are ideal for ostial lesions. This is at the expense of higher contrast utilization.

Answer 28

Coronary flow is reduced during guide engagement despite normalization of pressure waveform, so monitoring for ischemia via other signals remains important.

Answer 29

Length selection varies according to vessel distance from access site and equipment length used.

Answer 30

Longer catheters may be required for very tall patients or significant vessel tortuosity.

Answer 31

Shorter guide lengths facilitate cases in bypass grafts and complex chronic total occlusion (CTO) cases.

Answer 32

Yes, they may be manually shortened by trimming a distal section and reconnecting with a smaller interposed cut sheath.

Answer 33

Steerable, trackable, good tactile feedback

Answer 34

Balanced middle weight, run through, sion blue, pro water, choice PT

Answer 35

Navigating tortuosity and calcification. Examples are pilot 50 ( polymer jacketed). Tapered tip wires like fielder FC, SION black and whisper.

Answer 36

Good Penetration

Answer 37

Good Penetration

Answer 38

Pilot 200: 4.1 grams, Gladius 3.0 grams, Confienza pro 12 : 12.4 gms, Gaia 1: 1.7 gm Gaia 2 : 3.5 gm, Gaia 3 : 4.5 gm

Answer 39

Either polymer jacketed like pilot 200 or non-polymer jacketed like Gladius, Confianza pro 12 or Gaia one, two, three, etc.

Answer 40

The inner structure of the wire that extends from the proximal to distal end, but not all of the core material reaches the distal wire tip. Proximally, the core can be made of stainless steel, nitinol, or a composite of the two metals.

Answer 41

The composition of the core determines tip load, flexibility, steerability, trackability, and support for performing PCI.

Answer 42

Core thickness is proportional to wire support. The thicker the core, the better is the support.

Answer 43

Some cores taper, and the length of the taper is inversely proportional to the propensity for the distal wire tip to prolapse. The longer is the taper lengths, the lower the chance for the distal wire tip to prolapse.

Answer 44

If the core extends to the entire length of the wire, it is a 'core-to-tip' design that lends to increased tactile feedback and near 1:1 torque control.

Answer 45

They have a small metal ribbon that provides shape retention, softness, and tip flexibility at the expense of torque control.

Answer 46

Wires are generally 0.014" (0.36-mm) wires and have 0.014" tips, ( but some have tapered tips (0.10") examples are Fielder XT )

Answer 47

The wire body is around the core and is composed of coils or polymers.

Answer 48

Hybrid wires may have polymer for the body, known as a sleeve, and the distal tip is left uncovered.

Answer 49

The uncovered tip, better known as spring coils, provides good tactile feedback, shapeability, and shape retention.

Answer 50

Some wire may have polymer coating that extends to the tip coils that improves deliverability across calcified or tortuous anatomy at the expense of tactile feedback ( example pilot 50)

Answer 51

The wire body can be coated with an overlay that is hydrophilic or hydrophobic.

Answer 52

Hydrophilic coatings make wires lubricious, thus decreasing tactile feedback but improving navigation through tortuosity and calcium.

Answer 53

Hydrophobic coatings improve tactile feedback but are less slippery and decrease trackability.

Answer 54

Hybrid designs exist that combine HYDROPHOBIC TIP coils with hydrophilic intermediate coils to provide tactile feedback with trackability.

Answer 55

The translation of torque at the proximal end to the distal end for improved steering. The ultimate goal is 1:1 torque control from proximal shaft to distal tip.

Answer 56

The ability for the rest of the wire to follow and be advanced across stenoses or tortuosity once the distal tip crosses. This is also known as the deliverability or crossing.

Answer 57

Transmission of resistance to wire manipulation from distal tip to proximal body.

Answer 58

The load measured by the force required to buckle the tip when applied orthogonally to a standard surface. Soft wires have low tip loads, while higher tip loads are used for resistant plaque. Soft wires are frequently used for their atraumatic nature and safety profile . Higher tip loads are utilized for resistant plaque and frequently CTO.

Answer 59

Tip loads may vary from 0.5 to 25 g. Combining higher tip loads with tapered design will increase the penetration power of a wire.

Answer 60

Wire support is defined as guidewire‘ resistance to bending. Wires with more support, assist with device delivery and vessel straightening.

Answer 61

Wires generally come in short (180-190 cm) or long (300 cm) varieties.

Answer 62

Short wires can be compatible with wire extensions to convert them to appropriate lengths for exchanging longer over-the-wire devices (~135-150 cm).

Answer 63

They are specifically designed for externalization during CTO PCI, with extended coating to reduce friction and for greater ease of tracking.

Answer 64

The translation of torque at the proximal end to the distal end for improved steering. The ultimate goal is 1:1 torque control from proximal shaft to distal tip.

Answer 65

The ability for the rest of the wire to follow and be advanced across stenoses or tortuosity once the distal tip crosses.

Answer 66

Transmission of resistance to wire manipulation from distal tip to proximal body.

Answer 67

The load measured by the force required to buckle the tip when applied orthogonally to a standard surface. Soft wires have low tip loads, while higher tip loads are used for resistant plaque.

Answer 68

Tip loads may vary from 0.5 to 25 g.

Answer 69

Guidewire resistance to bending. Wires with more support assist with device delivery and vessel straightening.

Answer 70

Wires generally come in short (180-190 cm) or long (300 cm) varieties.

Answer 71

Short wires can be compatible with wire extensions ( DOC wire or Asahi extension) to convert them to appropriate lengths for exchanging longer over-the-wire devices (~135-150 cm) out of the body.

Answer 72

They are specifically designed for externalization during CTO PCI, with extended coating to reduce friction and for greater ease of tracking.

Answer 73

Buddy wire technique is when a supportive second wire is placed in parallel to straighten a vessel and assist with supporting device delivery. In general, less supportive wires navigate tortuousity better

Answer 74

Long wires, sacrifice torque control and they are usually difficult to manage. So instead of using a wire extension, trapping techniques are preferable if the guide size is sufficient.

Answer 75

Over-the-wire (OTW) and monorail/rapid exchange balloons.

Answer 76

OTW balloons have a central lumen for the wire and a separate lumen (hypotube) for balloon inflation.

Answer 77

It has largely been replaced by microcatheters due to improved performance.

Answer 78

Monorail balloons have a short segment with a lumen for both the balloon and the wire (what we use daily). The short segment allows for lower profile delivery and enables more equipment into a guide.

Answer 79

They have lower profile compared to over the wire balloons. They facilitate bifurcation and multivessel PCI, allowing more equipment to fit within guiding catheters. They also allow single operator PCI performance using 180 cm wires within monorail balloons.

Answer 80

Wolverine (Boston Scientific, Natick, MA).

Answer 81

Adjunctive technology such as lithotripsy (e.g., Shockwave Medical, Santa Clara, CA).

Answer 82

Ostial Flash (Campbell, CA).

Answer 83

Microcatheters are supportive catheters with a hydrophilic coating and a larger lumen compared to OTW balloons, minimizing friction during torquing.

Answer 84

Many microcatheters have a braided design to resist kinking in tortuous or calcified vessels.

Answer 85

Microcatheters support wire traversal, facilitate wire exchanges, dilate channels, allow distal drug delivery, and perform contrast injections.

Answer 86

Commercially available microcatheters vary in crossing profiles, torquability, deliverability, and lengths.

Answer 87

As catheter crossing profiles become smaller, pushability and torque transmission are sacrificed.

Answer 88

The Caravel, Finecross, and micro-14 microcatheters are good for navigating small channels because of the small crossing profile, but struggle with calcified channels ( less pushability and torque)

Answer 89

Corsair and Turnpike catheters are more supportive, have better torque transmission, and cross calcified channels more easily.

Answer 90

Turnpike LP, Mamba Flex, and Corsair Pro XS are lower profile and specifically designed for retrograde collateral crossing.

Answer 91

Lowest profile, good trackability

Answer 92

Length: 130, 150 cm; Distal Crossing Diameter: 1.8 FR

Answer 93

Good crossibility and trackability. ## Footnote Length: 135, 150 cm; Distal Crossing Diameter: 1.9 FR

Answer 94

Good crossability and trackability ## Footnote Length: 135, 150 cm; Distal Crossing Diameter: 2.1 FR

Answer 95

Excellent trackability ## Footnote Length: 135, 150 cm; Distal Crossing Diameter: 2.1 FR

Answer 96

Enhanced crossability and trackability. ## Footnote Length: 135, 150 cm; Distal Crossing Diameter: 2.2 FR

Answer 97

Excellent crossability and trackability ## Footnote Length: 135, 150 cm; Distal Crossing Diameter: 2.6 FR

Answer 98

Supportive catheter ## Footnote Length: 135, 150 cm; Distal Crossing Diameter: 2.6 FR

Answer 99

Supportive catheter for crossing calcified lesions ## Footnote Length: 130, 150 cm; Distal Crossing Diameter: 2.9 FR

Answer 100

Supportive catheter for crossing calcified lesions ## Footnote Length: 135 cm; Distal Crossing Diameter: 2.9 FR

Answer 101

Dual lumen catheter ## Footnote Length: 135 cm; Distal Crossing Diameter: 2 FR

Answer 102

Dual lumen catheter ## Footnote Length: 135 cm; Distal Crossing Diameter: 2 FR

Answer 103

Flexible, angled-tip catheter provides directional support ## Footnote Length: 130, 150 cm; Distal Crossing Diameter: 1.8 FR

Answer 104

Low profile, supportive catheter, however, less pushability.

Answer 105

Twin Pass (Teleflex) and Sasuke (Asahi Intecc) are designed for buddy wire delivery or distal delivery of intracoronary medications.

Answer 106

Bifurcation wiring, reverse wiring, parallel wiring, and distal delivery of buddy wires after crossing difficult lesions.

Answer 107

Guide extenders increase active support for coaxial delivery of coronary devices in challenging lesions.

Answer 108

It enables deep vessel engagement using a softer, more flexible tubular device compared to stiff guides.

Answer 109

Guideliner (Teleflex): 5, and 5.5 to 8 French, Guidezilla (Boston Scientific) with size 6 to 8 French, Telescope (Medtronic) with size 5.5 to 7 French and Trapliner (Teleflex) with a size 6 to 8 French.

Answer 110

They are usually used for active support for device delivery in torturous and calcified vessels. They can be used for thrombectomy, focusing contrast injections, and assisting with removal of trapped equipment such as atherectomy burrs.

Answer 111

Vessel dissection, stent deformation or dislodgement, and air embolism.

Answer 112

Use the catheters to introduce the guide extension into a vessel, and consider balloon-assisted tracking for tortuous vessels. This is done by inflating a small balloon to cover the edge of the guide extension, and either advancing the guide extension as a unit or advancing the balloon ahead of the guide extension, then inflating the balloon, followed by advancing the guide extension while the balloon is deflating, this is called inch worm technique.

Answer 113

It has a balloon within its lumen for trapping coronary wires and enabling exchange of OTW microcatheters and balloons.

Answer 114

The Rotablator is a rotational atherectomy device composed of an egg-shaped diamond-coated burr, except the 1.25 mm size, which is bullet shaped.

Answer 115

The Rotablator is available in many different sizes ranging from 1.25 mm to 2.5 mm.

Answer 116

The Rotablator is powered by compressed gas to spin a burr at speeds as high as 200K revolutions/minute.

Answer 117

A lubricant called Rotaglide is mixed and infused through the shaft of the device.

Answer 118

The Rotablator has a normal mode and a lower spin mode.

Answer 119

Dynaglide is typically used to minimize friction while traversing guide catheters or vessel tortuosity.

Answer 120

The Rotablator ablates calcium antegrade to the burr path.

Answer 121

The wire used is 0.010″ and the tip is 0.012″ designed to prevent the Rotaburr from traveling off the wire.

Answer 122

The two versions are the Rotaﬂoppy and Rotasupport wires.

Answer 123

The Rotasupport wire may be used preferentially to take advantage of wire bias in cases of eccentric calcium or ostial lesions.

Answer 124

The use of the Rotasupport wire is associated with an increased risk of perforation. its use remains selective.

Answer 125

The Diamondback 360 is an orbital atherectomy device by Cardiovascular Systems Inc that changes the diameter of the crown rotation based on spin speed.

Answer 126

The Diamondback 360 operates at two speeds: 80,000 and 120,000 revolutions per minute (rpm).

Answer 127

The diameter of ablation is influenced by spin speed, crown advancement speed, and duration of ablation.

Answer 128

Longer spins and slower crown advancement lead to larger spin diameters.

Answer 129

Unlike Rotablator, the CSI device ablates calcium radial to the crown and does not treat calcium antegrade to the burr.

Answer 130

ECLA is a laser device by Philips that uses a xenon-chloride monochromatic exciter laser to produce ultraviolet light bursts at 308 nm.

Answer 131

The ECLA operates with a pulse frequency of 25 to 80 Hz.

Answer 132

The ECLA ablates calcium through photochemical, photothermal, and photomechanical methods.

Answer 133

Photochemical energy can be titrated and is known as fluency.

Answer 134

Operators generally choose between 0.9 and 1.4 mm catheter sizes.

Answer 135

The two types of intravascular imaging are intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

Answer 136

Intravascular imaging provides detailed tissue composition, coronary dimensions, lesion length, plaque volume, and vessel diameter.

Answer 137

The two main types of IVUS are rotational IVUS catheters (frequency range between 35 and 65 MHz depending on the catheter type) and nonrotating phased array ( Eagle Eye catheter 20 MHz transducer frequency ) of multiple elements.

Answer 138

Rotational IVUS has higher imaging resolution but may cause potential nonuniform rotational disturbance (NURD).

Answer 139

Recent updates in catheter technology have decreased the incidence of nonuniform rotational disturbance (NURD).

Answer 140

OCT uses near-infrared light to produce high-definition cross-sectional anatomy.

Answer 141

The technique offers improved resolution compared with IVUS but with less tissue penetration.

Answer 142

Viscous media such as contrast must be injected during interrogation. Viscous media DISPLACE blood cells and prevent from obstructing the infrared light from the vessel wall.

Answer 143

It is injected to displace blood cells and prevent them from obstructing the infrared light from the vessel wall.

Answer 144

The two catheters on the market that perform OCT are the Dragonfly (Philips) and Vis-Rx (Nipro, Bridgewater, NJ).

Answer 145

To provide a marker for rewiring in case of side-branch occlusion, assist in anchoring the guiding catheter, facilitate access to the side branch, and allow passage of a small balloon behind the main vessel stent struts if needed.

Answer 146

The area of myocardium supplied by the side branch, lesion complexity, and the degree of disease in the ostial/proximal side branch.

Answer 147

A technique where the stent is sized to the distal vessel and consideration is given for postdilation of the stent proximal to the bifurcation.

Answer 148

Enough stent length must be present to allow for POT, with a minimum length determined by the shortest available balloon length (usually 6-8 mm).

Answer 149

By quantitative coronary angiography, intravascular imaging, or Finet’s formula.

Answer 150

A noncompliant balloon, ensuring the distal edge is inflated just proximal to the carina.

Answer 151

Leaving the side-branch wire in place while performing main vessel stenting and POT.

Answer 152

The possibility of wire damage and fracture when removing jailed wires.

Answer 153

They are more resistant to retrieval damage and more efficient in crossing the side-branch ostium than nonpolymer-coated wires.

Answer 154

Significantly lower rates of side-branch occlusion in patients with a side branch or main vessel stenosis ≥60%.

SCAI Chapter 14 PCI equipment guides Flashcards

(245 cards)