Question and Answers

What is thrombostar catheter?

• 6 Fr lowest profile
• Best internal diameter
• Round lumen and tip
• Best suction
• Core stylet inside to cross bends, curves, tortuosity
• Monorail within 2 cm of tip
• Hydrphylic coating in last 30 cm to helps slide down stenotic lesions to aspirate.

Finally best thrombus aspiration catheter in terms of suction of thrombus, flexibility, crossibility, pushebility, internal lumen as compare to other thrombo comic devises.

What is the problem of fibrotic lesions during PTCA?

Fibrotic lesions even if non calcified may not dilate with a NC balloon. And very high pressures balloon make dissect the vessel.

What is the problem of a DES?

• Drug disappears in 3 months time and taken care of problem of restenosis
• Polymer may remain permanent and become nidus for thrombosis and if DES is not endothelialized well, the metal and polymer create SAT and late stent thrombosis even after 2 to 3 years specially if DAP is discontinued.
• Sometimes polymer is inflammatory and if stent is not endothelialized then it can cause stent thrombosis.

What is ideal DES?

• Easy to deliver
• Polymer should disappear in four weeks time
• Drug should disappear in 28 days (maximum time of restenosis)
• Non-inflammatory stenosis

Which is a good approach in SVG PTCA?

• In fuzzy ulcerated lesions do direct stenting
• Otherwise predilate with small balloon and then implant of stent

What are the problems with 3.5 mm DES stent specially cypher?

• Difficulty in advancing DES across lesion
• Difficulty in removing balloon after deploying the stent
• With no proper guide support and guide wire, it is difficult to advance the stent

What is the benefit of PTCA in cardiogenic shock?

• Even 50 to 60 % improvement in TIMI flow improves the acute and long term outcome in LV function, mortality and morbidity.

Cardiogenic shock with RVMI and acute MR : option of treatment

• Best option is to stent the accluded RCA in AMI. There are chances that acute MR may disappear.

What is the approach of PTCA in AMI with TVD

• Culprit vessel PTCA first
• If Hemodynamics remain unstable, then only you do PTCA to another critically accluded vessel

What are the clinical situations prone to stent thrombosis?

• Diabetes
• Resistance to anti-platelets
• Discontinuation of anti platelets
• AMI
• Smaller final MLD
• Bifurcation stenting
• Patient with renal failure

Which are the conditions where long term DAP a MUST?

• Bifurcation stenting
• Long DES
• IDDM
• Renal failure

Innumerate anti-thrombin's

• Aspirin and clopidogrel
• LMWH
• IIb/IIIa glycoprotein inhibitor
• IV Bivaluridin

What are the causes of Hematoma in groin after introducing sheath in femoral arteries?

• Peri sheath oozing
• A small arterial branch puncture before and wire could not go and there was no adequate compression at the puncture site. So blood keeps oozing out of the side branch.

Which is a better carotid stent?

• Self expanding stent is better and it is best to Postdilate stent with a balloon
• Metallic balloon expandable stent are avoidable in the neck due to neck movements.

How to avoid Perforation of RV with temporary Pacing wire specially in RVMI?

• Use balloon tip pacing wire to 6 Fr bard pacing wire. Confirm position in LAO pacing wire to face towards the septum / spine

What is the deference between XB3 (Cordis) and EBU 3 (Metronic)?

• XB3 is like JL 4 and EBU 3 is like JL 3.5 guide catheters

What are the salient points of whisper wire?

• It is best wire for bends , curves and tortous vessels
• Best wire for retrograde thro collaterals for CTO
• The end of the wire is stiff so in very small branches it may cause perforation

What is the reason of a stent balloon not advancing forward after stent deployment?

• If balloon is getting stuck within the stent then inflate balloon and deflate and then it will easily go down to vessel
• The balloon sticks within the stent and it's not going forward if stent is not full expanded in that segment.

An RVMI with CHB - how long can you keep a temporary pacing wire?

• Maximum 5 to 7 days
• Longer you keep the wire more chances of perforation

What are the problems you face with angioplasty in ACS in patients with low platelet count?

• Some patients lower the platelet count with aspirin, clopidogrel and inj clexane
• Low platelets are reported more with clopidogrel then inj clexane
• Inj integrillin causes greater reduction in platelets
• Monitor platelet count when giving patient aspirin, clopidogrel, inj clexane and inj integrillin
• In patients with tendency to lowering platelets one can continue aspirin, clopidogrel and inj clexane. Inj integrillin can be started 2 to 3 hours, during and 2 hours after the procedure. If the platelet count after the procedure lowers less than 75000 than it is important to stop inj integrillin