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1 Following an intravascular ultrasound (IVUS) imaging of a moderately diseased coronary artery (see
left figure), offline measurements are performed (see
right figure). All of the following statements about
these measurements are true, except:
(A) Line A traces the leading edge of the intima,
defining the lumen area
(B) Line B traces the leading edge of the media,
defining the vessel area
(C) Line C is the minimal luminal diameter in this
cross section
(D) The difference between areas A and B represents
the atheroma area
(E) Line D represents the minimal atheroma thickness
2 The Reversal of Atherosclerosis with Aggressive Lipid
Lowering (REVERSAL) trial examined the effect of
intensive versus moderate lipid- lowering therapies
on coronary disease progression. All of the following
statements are true, except:
(A) The primary end point of the study was the
percentage change in the total atheroma volume
(TAV)
(B) The change in TAV was proportionate to the
change in the low density lipoprotein (LDL)
cholesterol level
(C) There was a significant reduction in the percent
TAV with intensive lipid lowering
(D) Therewas a significant progression in the percent
TAV in the moderate lipid-lowering arm
(E) There was no reported difference in the clinical
endpoints between the two arms of the study
3 A physically active 66-year-old hypertensive patient
is referred for coronary angiography because of
typical angina precipitated by moderate exertion. In
the catheterization laboratory, there is fluoroscopic
evidence of calcification in the left main trunk. Right
coronary angiography showed a severe focal lesion in
the mid segment. Left coronary angiography revealed
not only moderate disease in a marginal branch of
the circumflex artery, but more importantly it also
revealed, ostial left main disease (see left figure). An
IVUS imaging is then performed to better define the
left main trunk disease. The minimal lumen area in
the left main trunk was measured to be 7.4 mm2 (see
right figure). What is the most appropriate next step?
(A) Measure fractional flow reserve (FFR) distal to
the left main stenosis
192
Intravascular Ultrasound 193
(B) Place an intra-aortic balloon pump and arrange
for three-vessel bypass surgery
(C) Consider right coronary angioplasty for symptom relief
(D) Reevaluate the patient with a pharmacologic
nuclear stress test
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4 The OPTICUS study compared an ultrasoundguided stent implantation strategy with an
angiography-guided stent implantation strategy.
Which of the following statements regarding this
trial is true?
(A) There was no significant difference between both
groups in the restenosis rate at 6-month followup
(B) The significantly higher acute gain seen in
the ultrasound-guided stent implantation group
translated into a significantly lower acute loss
compared with the angiography-guided group
(C) An angiography-guided approach to stenting
was associated with an increased number of
balloons used per case
(D) Myocardial reinfarction was significantly reduced with the use of an ultrasound-guided
approach for stent implantation
(E) At 6 months, percent diameter stenosis was
significantly larger in the angiography-guided
arm
5 A 70-year-old male patient with hypertension and
hyperlipidemia presents with recurrent episodes of
chest burning for several days. His electrocardiogram
reveals T-wave inversion in leads V3 through V6 that
resolve with the resolution of chest pain. His troponin
I is 3.0, but the creatine kinase-MB (CK-MB) is
not elevated. Coronary angiography is performed:
The right coronary angiogram is unremarkable, and
the left coronary angiogram is seen here (figure
below). An IVUS imaging was then performed
to better define the mid left anterior descending
(LAD) segment. The (above) right and left figures
demonstrate the representative images from the LAD
at the level of the diagonal bifurcation and just
proximal to the bifurcation, respectively. On a review
of the angiograms and the IVUS images, which of the
following statements would be considered as correct?
(A) The haziness of the mid LAD is caused by heavy
calcification
(B) An IVUS imaging did not provide an explanation
for the angiographic haziness in the mid LAD
(C) The clinical management of the patient will be
influenced by the IVUS findings
(D) FFR in the distal LAD will be ≥0.85
(E) The patient is unlikely to develop more chest
pain
6 Following a difficult engagement of a large and
mildly diseased right coronary artery (RCA), a
subsequent angiogram reveals an extensive dissection
(see following figure). Emergent bailout stenting is
planned, and a guiding catheter is advanced to engage
the RCA. The angioplasty wire is passed to the distal
vessel with some difficulty.
194 900 Questions: An Interventional Cardiology Board Review
An IVUS catheter is then advanced over the wire
to confirm its position. The following figures are
obtained from the mid and proximal RCA. The next
best course of action is as follows:
(A) The wire should be removed and the procedure
terminated
(B) The wire should remain in place; percutaneous
transluminal coronary angioplasty (PTCA)
and/or stenting should follow
(C) The wire should be removed, and another
attempt at passing it in the true lumen should
be performed
(D) The wire should remain in place, but another
wire should be used to access the true lumen
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