Extreme tortuosity of the iliac system

Extreme tortuosity of the iliac system
Extreme tortuosity of the iliac system
1. The largest rotablator burr size that will fit through a
6 French standard Cordis guide catheter is a:
(A) 1.25-mm burr
(B) 1.5-mm burr
(C) 1.75-mm burr
(D) 2.0-mm burr
(E) 2.15-mm burr
2. A patient is transferred from an outpatient diagnostic center where 5 F diagnostic catheters were
used to identify a 70% LAD lesion. When you
cannulate the left main with your guiding catheter,
ventricularization is noted as shown in the following
figure. Appropriate responses to the observation of
ventricularization encountered on routine coronary
intervention during cannulation of the left coronary
system using a 6 French guiding system include all of
the following, except:
II
V
P1 LV
200
180
160
140
120
100
80
60
40
20
0
4:27:50 PM 4:27:52 PM 4:27:56 PM4:27:54 PM 4:27:58 PM
1,000 ms
(A) Repositioning the guiding catheter to reevaluate
the wave form and assess catheter tip relationships
(B) Proceeding with the coronary intervention because ventricularization is frequently seen during cannulation of the left main coronary artery
(C) Performing a more thorough evaluation of the
coronary tree using intravascular ultrasound
(IVUS)
(D) All of the above
(E) None of the above
10 Prolonged radial artery cannulation is associated with
compromise of the radial artery occlusion rates in
what percentage of patients?
(A) 2% to 10%
(B) 10% to 15%
(C) 15% to 20%
(D) 25% to 30%
(E) None of the above
11 A common complication associated with the radial
artery approach is occlusion of the radial artery. This
occurs in the following percentage of cases when
procedures are not prolonged:
(A) 20%
12 Legitimate concerns that should be considered when
selecting larger lumen guide catheters over smaller
Guiding Catheter Selection for Coronary Interventions 51
lumen guide catheters include all of the following,
except:
(A) Increased potential for trauma at the ostium of
the artery selected for intervention
(B) Larger defect at the access site for sheath introduction and consequent delayed ambulation
(C) Contrast volume
(D) All of the above
(E) A and B
13 Extreme tortuosity of the iliac system and aorta will
often present problems with cannulation of both the
right and the left coronary artery. The most efficient
technical maneuver that can overcome peripheral
and aortic tortuosity includes:
(A) After sheath introduction, immediate use of the
0.038 ‘‘stiff’’ wire for negotiation of the tortuosity
(B) Use of the coated wire (e.g., glide wire) to
negotiate the tortuosity and enter the ascending
aorta
(C) Use of an 0.068 Arani wire after the sheath has
been inserted and advancing the Arani wire into
the ascending aorta, followed by advancing the
guide catheter over the Arani wire
(D) Initial negotiation of the tortuosity with a glide
coated wire or soft wire followed by advancing
the guide catheter into the ascending aorta. The
coated wire or soft wire can then be removed
and a stiffer 0.038 wire placed into the guide
to facilitate further advancement of the guiding
catheter into the appropriate coronary cusp and
cannulation of the appropriate coronary artery
(E) None of the above
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