CCS Cardiovascular Treatment Procedures 2 — Questions and Answers
Question 1: During transcatheter aortic valve replacement (TAVR), which vascular access site is most commonly used?
- Subclavian artery
- Femoral artery (Correct answer)
- Carotid artery
- Axillary artery
Correct answer: Femoral artery
The transfemoral approach is the most common access route for TAVR due to its lower complication rates and faster recovery.
Question 2: A patient undergoes coronary artery bypass grafting (CABG). The left internal mammary artery (LIMA) is preferentially used to bypass which vessel?
- Right coronary artery
- Left anterior descending artery (Correct answer)
- Circumflex artery
- Obtuse marginal artery
Correct answer: Left anterior descending artery
The LIMA-to-LAD graft has superior long-term patency rates compared to saphenous vein grafts, making it the preferred conduit for LAD bypass.
Question 3: Which pharmacologic agent is administered during a stress test when a patient cannot exercise adequately?
- Dobutamine or adenosine (Correct answer)
- Nitroglycerin
- Metoprolol
- Digoxin
Correct answer: Dobutamine or adenosine
Pharmacologic stress agents such as dobutamine (inotropic) or adenosine/regadenoson (vasodilators) are used when patients cannot achieve adequate exercise.
Question 4: What is the purpose of using an intra-aortic balloon pump (IABP) in cardiogenic shock?
- Increase afterload to raise blood pressure
- Provide counterpulsation to reduce afterload and improve coronary perfusion (Correct answer)
- Deliver thrombolytics directly to coronary arteries
- Electrically pace the ventricle
Correct answer: Provide counterpulsation to reduce afterload and improve coronary perfusion
The IABP inflates during diastole to augment coronary perfusion and deflates during systole to reduce afterload, supporting the failing heart.
Question 5: A patient with hypertrophic obstructive cardiomyopathy (HOCM) fails medical therapy. Which catheter-based procedure reduces the outflow obstruction?
- Percutaneous mitral balloon valvuloplasty
- Alcohol septal ablation (Correct answer)
- Transcatheter mitral valve replacement
- Pulmonary vein isolation
Correct answer: Alcohol septal ablation
Alcohol septal ablation involves injecting alcohol into the first septal perforator artery to induce a controlled infarction and reduce the hypertrophied septum.
Question 6: Which finding on coronary angiography would most strongly indicate the need for fractional flow reserve (FFR) measurement?
- Total occlusion of the RCA
- Intermediate stenosis of 40–70% in a major coronary artery (Correct answer)
- Severe stenosis >90% causing angina
- Presence of collateral vessels
Correct answer: Intermediate stenosis of 40–70% in a major coronary artery
FFR is most useful for intermediate lesions (40–70%) where visual assessment alone cannot reliably determine hemodynamic significance.
Question 7: After placement of a drug-eluting stent (DES), dual antiplatelet therapy (DAPT) is typically continued for at least how long?
- 2 weeks
- 1 month
- 6 months
- 12 months (Correct answer)
Correct answer: 12 months
Current guidelines recommend at least 12 months of DAPT after DES implantation in ACS patients to prevent late stent thrombosis.
CCS Cardiovascular Treatment Procedures 2
During transcatheter aortic valve replacement (TAVR), which vascular access site is most commonly used?