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24 Cards in this Set

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What year is the year for which CABG was no longer the only alternative to medicine for the treatment of CAD? Also the year Pam was married
1977
What does PTCA stand for?
Also POBA
Percutaneous transluminal coronary angioplasty
Plain old ballon angioplasty
What is a PTCA?
Alternative to CABG-which the NARROWED portion of the artery can be enlarged SELECTIVELY without surgery by a ballon to open blocked artery
What does PCI stand for?
percutaneous coronary Intervention
-balloons-stents-cutters, grinders
Intervention
A technique for remodeling a blood vessel throught the introduction of an expandable stent, balloon cathater, or other speialized tool for treating disease
Average hosptal stay after performing stent palcenment-if no complications occur
only one more day so thats 2 days
How balloon angioplasty works
Disruption of plaque and arterial wall
The inflated balloon exerts pressure against the plaque and arterialwall, causing fracturing and splitting a plaque
where does concentric lesions fracture and split?
At the vessels thinnest and weakest point
Where does eccentric lesions split?
At the junction of the plaque and the arterial wall
What during this the procedure might result in a larger lumen
Dissection or seperation of the plaque from the medial wall results in a larger lumen
This is the majopr effective mechanism of balloon angioplasty
Balloon dilation causes stretching and thinning of the _____________ wall of the artery
medial
What will stretching of the medial wall cause?
It will cause it to loose its elastic property
What effects the degree of elastic recoil loss?
Balloon to artery size ratio
About how long does it take for there to be renarrowing of the artery as a result of elastic recoil
About 1-6 weeks
What would help prevent the renarrowing of an artery
Placement of a stent in the artery
what would shear pressures casue?
Denudation or stripping of endothelial cells and extrusion or pushing out of plaque components
There may be moldong of _____, but this effect accounts for a small part of the opverall effect of angioplasty
softer lipid material
Mechanism of stents
Stents scaffold the _____ and _______ open.
lumen
plaque
Stents hold back ____________flaps and stop
________ and renarrowing of the lumen
dissection
recoiling
PCI Indications
Angina pectoris-despite optimal medical therapy

Mild anginapectoris w/ objective evidence of ischemia
(abn stress test)
High grade lesion of a vessel supplying large area of the myocardium (>70%)
PCI Indications
AMI as primary therapy or have persistant ischemia or failed thrombolytic therapy
Angina pectoris after CABG
Restenosis after successful PCI
PCI Contraindications
– 1) Unsuitable coronary anatomy.
– 2) Extremely high-risk coronary anatomy in which
closure of vessel would result in patient death.
– 3) Contraindication to CABG surgery (however, some
patients have PCI as their only alternative to
revascularization).
– 4) Bleeding diathesis.
– 5) Patient noncompliance with procedure and post-PCI
instructions.
– 6) Multiple PCI restenosis
– 7) Patients who cannot give informed consent.
PCI complications
• 1) Death (<1%)
• 2) MI (<3-5%)
• 3) Emergency CABG surgery (<3%) and abrupt vessel closure
(0.8%).
• 4) All the complications that can occur during a cardiac cath;
access site bleeding is more common.
• Although no a true complication, restenosis, intimal hyperplasia
at the site of PCI, occurs in about 10-30% of patients after
placement of a stent, leading to recurrence of anginal
symptoms.
• Typically, restenosis occurs in the initial 6 months after PCI.
• In-stent restenosis is expected to be <10% with drug-eluting
stents.
PCI Equipment
THe guiding catheter
ballon, stent, or atherectomy catheter
coronary guidewire