Interventional procedures are domain C of the RCIS exam: 34% of the scored items, roughly 51 of the 150, spread over 14 task lines from pacemaker implants and PCI through closure devices, mechanical support and temporary pacing to transcatheter valves. The questions put you in the room as the technologist: pick the device, read the pressure that says something went wrong, know what to prepare next.
The outline CCI publishes lists 14 task lines under domain C and weights only the domain, never a single task. Read the table as a map of where questions come from; the summaries are ours, not the outline's.
| Task | What the line covers | What the questions test |
|---|---|---|
| C1 | Device implants: pacemaker, ICD, CRT, loop recorder | Pocket and lead problems, antibiotic timing |
| C2 | Coronary balloon and stent | Heparin and ACT, post-dilation, bifurcations |
| C3 | Vascular closure devices | What each device leaves in the artery |
| C4 | CTO, atherectomy, alcohol septal ablation | Burr sizing, device speeds, heart block |
| C5 | Peripheral: renal, leg, IVC filter, stenting | Filter landmarks, stent choice, ABI |
| C6 | Complex peripheral: carotid, limb ischemia | Carotid sinus reflex, protection |
| C7 | Mechanical support: IABP, LVAD, Impella, ECMO | Balloon timing, contraindications |
| C8 | Temporary transvenous pacing | Output, sensitivity, capture failure |
| C9 | Pericardiocentesis | Approach and needle direction |
| C10 | Coronary thrombectomy | When aspiration is indicated |
| C11 | Peripheral thrombectomy and thrombolysis | Grading acute limb ischemia |
| C12 | Distal embolic protection | Vein grafts and carotid stents |
| C13 | Septal defects, LAA | Transseptal access, which defects close |
| C14 | Valvuloplasty, TAVR, repair, leak | Rapid pacing, TAVR complications |
Two changes arrived with the content outline used for exams from July 1, 2024: closure devices became their own task (C3) and ECMO joined mechanical support (C7). The endovascular aortic task left the list, so an old review chapter on aneurysm repair is low priority now.
Share of scored items by domain, content outline for exams from July 1, 2024 (CCI, checked September 2026).
Domain C sits second behind diagnostic procedures, and it keeps borrowing B's hemodynamics: you cannot spot acute mitral regurgitation after a valvuloplasty without a normal wedge trace in your head. The diagnostic procedures guide covers that side.
C2 questions follow the order of a case: guide, wire, balloon, stent, post-dilation. Know one standard choice at each step and the one reason it would change.
Heparin for PCI is weight-based, and the ACT target depends on two things the stem will give you: whether a GP IIb/IIIa inhibitor is planned, and which ACT device the lab uses. Without a IIb/IIIa the target is 250–300 s on a HemoTec, about 50 s higher on a Hemochron; with one it is 200–250 s. Bivalirudin is the choice in heparin-induced thrombocytopenia and has no reversal agent.
Heparin bolus range for PCIWorking
6,300–9,000 U without a IIb/IIIa; 4,500–6,300 U with one
The slip the exam baits: one ACT number with no device named.
A noncompliant balloon holds its diameter at high pressure, so it does the post-dilation. Keep it shorter than the stent and fully inside it: inflating past the edge stretches unsupported artery and opens an edge dissection. Bifurcation items describe the steps and ask for the name, so learn the five techniques by sequence.
| Technique | What happens, in order |
|---|---|
| Provisional | Stent the main branch; treat the side branch only if it is compromised |
| Crush | Side-branch stent protrudes into the main vessel; the main-vessel stent flattens it |
| Culotte | Two stents overlap in the proximal main vessel, one from each branch |
| TAP | Main-vessel stent, then a side-branch stent with minimal protrusion, then kissing |
| Simultaneous kissing stents | Two stents deployed together, side by side, forming a new carina |
Closure devices gained their own line in 2024, and the questions go after mechanism, not brand trivia: what sits inside the artery, what sits outside, what that means for the next puncture.
| Device | Mechanism | What the exam asks |
|---|---|---|
| Angio-Seal | Anchor inside the artery, collagen plug outside, joined by a suture | Re-puncture within 90 days at least 1 cm above the old site |
| Perclose ProGlide | Suture through the arterial wall, knot pushed down | Above 8F, preclose with two or more devices |
| Mynx | Sealant placed outside the artery with a temporary balloon | Nothing stays in the lumen |
| Manual compression | Pressure above the puncture after the pull | Femoral sheath out once ACT is below about 150–180 s |
After closure, the puncture level predicts the complication. Above the inguinal ligament: retroperitoneal bleed, with falling pressure, flank pain and little to see at the groin. At or below the bifurcation: pseudoaneurysm (systolic bruit) or AV fistula (continuous bruit).
C4 groups three procedures with one exam angle: you set up and watch the device, and you know the complication each one is known for.
Rotational atherectomy spins a diamond-coated burr at about 140,000–150,000 rpm, sized to roughly half the vessel. Orbital atherectomy has two speeds, about 80,000 and 120,000 rpm, and starts low. A lithotripsy balloon is sized 1:1, inflated to 4 atm and fires 10 pulses per cycle. Slow flow, no-reflow and perforation are the shared risks.
Rotational atherectomy burr sizeWorking
A 1.5 or 1.75 mm burr; 2.0 mm (2.0 ÷ 3.0 ≈ 0.67) is already past the 0.6 target, and anything above 2.1 mm crosses the 0.7 ceiling
Ratios above about 0.7 raise the complication rate.
CTO items lean on equipment roles: dual injection to see the far vessel through collaterals, a microcatheter to back up the wire, antegrade or retrograde crossing. In septal ablation for obstructive hypertrophic cardiomyopathy, alcohol goes into a septal branch of the LAD after a balloon seals it, and complete heart block is the complication, so a temporary pacing wire is placed first.
C7 names four devices, and the exam tests them as contrasts: which one unloads the ventricle, which one needs a competent aortic valve, which one adds a lung.
The helium balloon sits in the descending aorta, tip about 2 cm below the left subclavian origin. It inflates at the dicrotic notch and deflates just before systole, usually triggered from the R wave. Timed right, assisted end-diastolic and assisted systolic pressures are both lower than unassisted. Moderate or worse aortic regurgitation, dissection, aneurysm and severe peripheral disease rule it out.
| Error | On the arterial trace | Effect |
|---|---|---|
| Early inflation | Augmentation starts before the dicrotic notch | Raises afterload; most dangerous |
| Late inflation | Notch visible before augmentation rises | Less coronary perfusion |
| Early deflation | Sharp drop after augmentation | No afterload reduction |
| Late deflation | Assisted end-diastolic pressure at or above unassisted | Raises afterload |
Impella is a microaxial pump across the aortic valve, pulling blood from the LV into the ascending aorta. LV thrombus, a mechanical aortic valve and moderate or worse AR are the contraindications to flag. VA-ECMO supports heart and lungs, VV-ECMO lungs only. Femoral VA-ECMO pumps against the ventricle, raising LV afterload, and can leave the upper body on poorly oxygenated blood, so oxygenation is checked at the right radial artery. A continuous-flow LVAD can leave no palpable pulse, so pressure is read as a mean.
Run the full case log on your phone
The app carries the larger RCIS question bank with the same explanations, sorted by the five exam domains.
C8 to C12 are short procedures with one or two decisions each. Learn the decision, then the number that goes with it.
C8 · Temporary transvenous pacing
Output at two to three times the capture threshold. Sensitivity is in millivolts, and a lower number is more sensitive, so undersensing is fixed by turning it down. Spikes without a QRS are failure to capture. Rapid pacing for TAVR or valvuloplasty runs at about 180–220 bpm.
C9 · Pericardiocentesis
Subxiphoid, needle at 30–45° to the skin, aimed at the left shoulder. ST elevation on the needle lead means myocardial contact: pull back.
C10 · Coronary thrombectomy
Routine aspiration in STEMI showed no benefit in TOTAL and TASTE; it is a selective or bailout tool.
C11 · Peripheral thrombectomy and thrombolysis
Questions grade acute limb ischemia by the Rutherford classes below.
C12 · Distal embolic protection
Used for vein-graft PCI and carotid stenting. Carotid post-dilation can trigger the sinus reflex, dropping rate and pressure; have atropine ready.
| Class | Sensory loss | Weakness | Arterial Doppler |
|---|---|---|---|
| I · Viable | None | None | Audible |
| IIa · Marginally threatened | Toes only | None | Often inaudible |
| IIb · Immediately threatened | Beyond the toes | Mild to moderate | Inaudible, venous audible |
| III · Irreversible | Profound | Paralysis | Arterial and venous inaudible |
TAVR items ask about complications and what to prepare: complete heart block (more often with self-expanding valves), paravalvular leak, coronary obstruction, annular rupture, stroke and access injury. Iliac bleeding after a large-bore sheath comes out is controlled first with an occlusion balloon from the other side. During valvuloplasty, a sudden tall v wave with a rising left atrial mean, while the gradient falls, is acute mitral regurgitation.
MitraClip and Watchman start from the femoral vein with a transseptal puncture. Only secundum ASDs close percutaneously, and after an LAA occluder a leak wider than 5 mm is significant. An IVC filter sits below the lowest renal vein, which the cavogram marks first. For implants, cefazolin goes in within 60 minutes before the incision, and leads coiled around a turning generator are twiddler syndrome.
| Ankle-brachial index | Reading |
|---|---|
| Above 1.40 | Noncompressible: use the toe-brachial index |
| 1.00–1.40 | Normal |
| 0.91–0.99 | Borderline |
| 0.90 or less | Peripheral artery disease; 0.40 or less is severe |
Seven beliefs found in prep material during the content audit behind this site's question bank. Each is wrong on the current exam.
| What the weak key says | What is correct |
|---|---|
| IABP early inflation or late deflation helps augmentation | Both raise afterload |
| Nitroglycerin treats no-reflow | Adenosine, verapamil, nitroprusside or epinephrine do |
| Aspiration thrombectomy is routine in STEMI | Selective or bailout only |
| Higher mV setting = more sensitive pacer | Lower mV number = more sensitive |
| Pericardiocentesis aimed at the right shoulder | Left shoulder |
| Mynx leaves an anchor in the artery | That is Angio-Seal |
| Pseudoaneurysm has a continuous bruit | Systolic; continuous is AV fistula |
Twelve domain C cases, one per screen, with a note on every option: implant problems, nitrate safety, post-dilation, carotid stenting, IVC filters, limb ischemia, Impella screening, pacing and three valve cases, one of them a valve-area calculation. The pacing strip holds you to the exam's rate: 2 hours 50 minutes of question time for 170 questions, about a minute a case.
Six weeks after a dual-chamber pacemaker implant, a patient is brought in for lead revision because of intermittent loss of capture and rhythmic left arm twitching. Fluoroscopy shows both leads wound around the generator like a rope, with the tips pulled back. What is the most likely cause?
Pick an answer. The verdict, the explanation and a note on every option appear here.
Then run the mixed RCIS practice test, or open the worked exam questions for line-by-line solutions.
Map the 14 lines
Mark the task lines you have never scrubbed for; study those first.
Write every setting with its direction
IABP timing, pacer sensitivity, needle angle, burr ratio: one sheet, a number and a direction each.
Drill, then mix
Repeat the 12 cases until you can explain every wrong option, then take the full practice test.
Key takeaways
Domain C's 14 task lines cover device implants, coronary balloon and stent work, closure devices, complex coronary and peripheral work, mechanical support (IABP, LVAD, Impella, ECMO), temporary pacing, pericardiocentesis, thrombectomy, distal protection, septal and LAA closure, and percutaneous valves: 34% of the scored exam.
The IABP is named in the mechanical-support line (C7), and timing is the classic way to test it: you read an arterial trace and say whether inflation or deflation is early or late. CCI does not publish item counts for single tasks.
It helps, but the items describe the trace or the device and ask for the next step, which you can learn from the reference texts. If your lab does little structural work, start with C13 and C14. The eligibility pathways set the experience you need to apply.
Work the free case run here, then carry the full RCIS bank with you: the app sorts questions by the same five domains and keeps the explanation for every option.