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What is the indication for Rotation Atherectomy?
Patient with coronary artery disease who are candidates for CABG
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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
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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
- -Hypotension
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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
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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)
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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.
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What are the max RPMs of an airpowered turbine?
200,000 RPM
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What components are part of the console that the turbine is connected to?
- -Pressure gauge and control knob
- -Tachometer
- -Event Timer
- -Procedure Timer
- -Dynaglide Indictor
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What type of compressed gas is used for the console?
Nitrous
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What is the largest burr size? What is the smallest burr size?
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Burr sizes increase in _________ sizes.
.25mm (1.25, 1.5, 1.75 etc)
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What is the max Fr size a 2.0mm burr used in?
6Fr
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Maximum burr diameter should not exceed ______ of reference size.
70-80%
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What is the rotablader primarily used on?
Hard calcified and long lesions
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What should you be cautious when using the cooling solution for the rotablader?
Patient can experience Hypotension
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What are the three types of lesions that rotational atherectomy are effective in?
- -Complex Lesions
- -Ostial Lesions
- -Restenotic Lesions
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In 1990, the FDA approved Directional Coronary Atherectomy (DCA) for what type of lesions?
Bifurcation and Ecentric Lesions
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What rate does the cutter head rotate in the DCA?
2000-2500 RPM
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When is a DCA considered succesfful?
If there is 50% residual
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Thrombus aspiration systems my reduce thrombus in a vessel by _______.
+/- 86%
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What size sheath do you use for a Thrombus Aspiration system?
6 French with a 4 or 5 French aspiration catheter
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What speed is the saline propelled at during thrombus aspiration?
450km/hour
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What is the pressure of the water in an aspiration cathere?
10,000 psi
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What rate should the aspiration catheter be pulled?
0.5mm/second
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To keep thrombus and particular debris sluffed off vessel walls is the purpose of what device?
Filter wires/Distal Protection Devices
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Filter Wires/Distal Protection Devices are most commonly used in _____ with diameters of ______.
SVG; 3.5mm - 5.5mm
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In regards to filter wires/distal protection devices, what does the mesh basket allow during the procedure?
Distal profusion
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What are some indications for using cutting balloons?
- - In stent restenosis
- - Bifurcation lesions
- - Ostial Lesions
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What are contraindications of using a cutting balloon?
- - Heavily calcified lesions
- - total occlusion
- - Vessels < 2mm in diameter
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What is another term for the 3-4 blades on a cutting balloon?
Athertomes
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What is the thickness and length of an Athertome?
- 0.1 - 0.4mm in diameter
- runs the length of the balloon
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What pressure is the inflation of a cutting balloon limited to?
4-6 atm
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What is used to vaporize plaque?
Lasers
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What are two types of lasers?
- Ultraviolet (Excimer)
- Infared Laser (Yag)
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Although lasers have shown promise the _______ rate is no better than POBA.
Restenosis
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What treatment is described as Radiation treatment, and was primarily developed for instant restenosis?
Brachial Therapy
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If the dose is too high in Bracial therapy, then _______ can form.
aneurysm
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What requirements are needs to perform Brachial therapy?
Extensive LICENSING requirements for the facility and extensive STAFFING requirements
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Who should be present in the room during a brachial therapy procedure?
- Medical Physicist
- Radiation Oncologist
- Interventional cardiologist
- Trained support staff
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