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What is the indication for Rotation Atherectomy?
Patient with coronary artery disease who are candidates for CABG
What is the critera for CABG canidate to receive Rotationl Atherectomy?
- -Single Vessel atherosclerotic lesion can be crossed w/guide wire
- - Multi vessels disease w/out undue risk
- -Prior PTCA w/restenosis of native vessel
- -Lesion is less than 25mm long
What are contraindications for Rotational Atherectomy?
- -Occlusions through whole wire will not cross
- -Last remaining vessel w/compromised LV function
- -Saphenous Vein Grafts (SVG)
- -Angiogrpahic evidence of thrombus to Atherectomy
- -Dissection at treatment site
What makes a patient a high risk for Rotational Atherectomy?
- -Not canidate for CABG
- -Severe diffuse 3 vessel disease
- -Unprotected LMCA disease
- -Ejection Fraction < 30%
- -Lesion > 25mm
- -Lesions > 45degree angulated lesion
What is the size of the guide wire that is attached to the drive shaft?
0.009 inches x 300cm wire (standard, floppy, or extra support)
How is the solution of Heparine, Saline, Verapamil, and Nitro-Gyclerine used for a Rotational Atherectomy procedure?
It pressurized and infused to the keep the burr of the rotoblader cool when in operation.
What are the max RPMs of an airpowered turbine?
What components are part of the console that the turbine is connected to?
- -Pressure gauge and control knob
- -Event Timer
- -Procedure Timer
- -Dynaglide Indictor
What type of compressed gas is used for the console?
What is the largest burr size? What is the smallest burr size?
Burr sizes increase in _________ sizes.
.25mm (1.25, 1.5, 1.75 etc)
What is the max Fr size a 2.0mm burr used in?
Maximum burr diameter should not exceed ______ of reference size.
What is the rotablader primarily used on?
Hard calcified and long lesions
What should you be cautious when using the cooling solution for the rotablader?
Patient can experience Hypotension
What are the three types of lesions that rotational atherectomy are effective in?
- -Complex Lesions
- -Ostial Lesions
- -Restenotic Lesions
In 1990, the FDA approved Directional Coronary Atherectomy (DCA) for what type of lesions?
Bifurcation and Ecentric Lesions
What rate does the cutter head rotate in the DCA?
When is a DCA considered succesfful?
If there is 50% residual
Thrombus aspiration systems my reduce thrombus in a vessel by _______.
What size sheath do you use for a Thrombus Aspiration system?
6 French with a 4 or 5 French aspiration catheter
What speed is the saline propelled at during thrombus aspiration?
What is the pressure of the water in an aspiration cathere?
What rate should the aspiration catheter be pulled?
To keep thrombus and particular debris sluffed off vessel walls is the purpose of what device?
Filter wires/Distal Protection Devices
Filter Wires/Distal Protection Devices are most commonly used in _____ with diameters of ______.
SVG; 3.5mm - 5.5mm
In regards to filter wires/distal protection devices, what does the mesh basket allow during the procedure?
What are some indications for using cutting balloons?
- - In stent restenosis
- - Bifurcation lesions
- - Ostial Lesions
What are contraindications of using a cutting balloon?
- - Heavily calcified lesions
- - total occlusion
- - Vessels < 2mm in diameter
What is another term for the 3-4 blades on a cutting balloon?
What is the thickness and length of an Athertome?
- 0.1 - 0.4mm in diameter
- runs the length of the balloon
What pressure is the inflation of a cutting balloon limited to?
What is used to vaporize plaque?
What are two types of lasers?
- Ultraviolet (Excimer)
- Infared Laser (Yag)
Although lasers have shown promise the _______ rate is no better than POBA.
What treatment is described as Radiation treatment, and was primarily developed for instant restenosis?
If the dose is too high in Bracial therapy, then _______ can form.
What requirements are needs to perform Brachial therapy?
Extensive LICENSING requirements for the facility and extensive STAFFING requirements
Who should be present in the room during a brachial therapy procedure?
- Medical Physicist
- Radiation Oncologist
- Interventional cardiologist
- Trained support staff