CIR CIR Equipment Technology & Device Management 2 — Questions and Answers
Question 1: What is the recommended method for flushing an arterial sheath during a cardiac catheterization procedure to prevent thromboembolism?
- Intermittent manual flush with heparinized saline every 30 minutes
- Continuous pressure-bag flush with heparinized saline at 3 mL/hr (Correct answer)
- Gravity drip of normal saline at keep-open rate
- Flushing only when resistance is felt
Correct answer: Continuous pressure-bag flush with heparinized saline at 3 mL/hr
Continuous pressure-bag flushing with heparinized saline at approximately 3 mL/hr maintains sheath patency and prevents thrombus formation around the indwelling device.
Question 2: During coronary intervention, a guide catheter with deep intubation of the left main is noted. What is the primary risk of this position?
- Increased radiation dose to the operator
- Ostial dissection or vessel occlusion (Correct answer)
- Loss of pressure waveform accuracy
- Excessive contrast injection volume
Correct answer: Ostial dissection or vessel occlusion
Deep intubation of a guide catheter into the left main increases the risk of traumatic ostial dissection, which can cause acute vessel closure and hemodynamic collapse.
Question 3: An intravascular ultrasound (IVUS) catheter is best used intraproceduarlly to:
- Measure fractional flow reserve across a stenosis
- Assess plaque morphology, true lumen dimensions, and stent apposition (Correct answer)
- Deliver targeted pharmacotherapy to the vessel wall
- Monitor real-time electrophysiology signals
Correct answer: Assess plaque morphology, true lumen dimensions, and stent apposition
IVUS provides cross-sectional imaging of vessel wall architecture, enabling accurate lumen sizing, plaque characterization, and confirmation of complete stent expansion and apposition.
Question 4: Which embolic protection device works by capturing debris released during carotid artery stenting?
- Bare metal stent with open-cell design
- Distal filter wire placed beyond the lesion (Correct answer)
- Proximal balloon occlusion of the common carotid
- Aspiration guide catheter positioned at the ostium
Correct answer: Distal filter wire placed beyond the lesion
A distal filter wire is deployed beyond the target lesion to capture particulate emboli dislodged during stenting before they can travel to the cerebral circulation.
Question 5: What is the purpose of a rotational atherectomy (Rotablator) burr in percutaneous coronary intervention?
- To aspirate thrombus from within the coronary artery
- To ablate calcified plaque using high-speed diamond-coated burr rotation (Correct answer)
- To deliver laser energy to vaporize soft plaque
- To score calcified plaque with embedded blades
Correct answer: To ablate calcified plaque using high-speed diamond-coated burr rotation
The Rotablator uses a diamond-coated burr rotating at 140,000–180,000 RPM to ablate and pulverize calcified coronary plaque into micro-particles small enough to pass through the microcirculation.
Question 6: When a drug-eluting stent (DES) is deployed, the polymer coating serves primarily to:
- Provide radiopacity for fluoroscopic visualization
- Control the elution rate of antiproliferative drug into the vessel wall (Correct answer)
- Increase stent flexibility for tortuous anatomy
- Prevent galvanic corrosion of the metallic platform
Correct answer: Control the elution rate of antiproliferative drug into the vessel wall
The polymer coating on a DES acts as a reservoir that controls the sustained, time-dependent release of antiproliferative agents (e.g., sirolimus, paclitaxel) to inhibit neointimal hyperplasia.
CIR CIR Equipment Technology & Device Management 2
What is the recommended method for flushing an arterial sheath during a cardiac catheterization procedure to prevent thromboembolism?