ABIMEXAM/ABIM INTERVENTIONAL CARDIOLOGY
ACTUAL EXAM 2026-2027 COMPLETE ACCURATE EXAM
REAL QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES (100% RELIABLE ANSWERS)
CURRENTLY UPDATED VERSION EDITION 2026
|GUARANTEED PASS A+ (BRAND NEW!!) |INSTANT
DOWNLOAD PDF
1. A 72-year-old male with a history of non-ST-elevation myocardial infarction
(NSTEMI) three years ago, status post two drug-eluting stents (DES) to the left
anterior descending (LAD) artery, presents with recurrent exertional angina. He is
on aspirin, clopidogrel, atorvastatin, and metoprolol. Coronary angiography reveals
a 70% in-stent restenosis (ISR) at the proximal edge of the previously placed stent.
Intravascular ultrasound (IVUS) is performed. Which of the following IVUS
findings would most strongly predict a favorable long-term outcome following
percutaneous coronary intervention (PCI) with a drug-eluting balloon (DEB) for
this lesion?
A.A minimum lumen area (MLA) of 2.5 mm²
B.A prominent, eccentric, hypoechoic neointimal hyperplasia without significant
calcification
C.Incomplete stent apposition at the distal edge
D.A neoatherosclerotic, echogenic, superficial calcified nodule
E.An echodense, homogeneous, circumferential neointima
,Answer: B
Rationale: DEB therapy is most effective for ISR when the underlying mechanism
is predominantly neointimal hyperplasia, which appears as a hypoechoic (soft)
tissue. The presence of significant calcification (echogenic) or neoatherosclerosis
reduces drug transfer and efficacy. IVUS helps characterize the plaque; soft, non-
calcified lesions allow for better paclitaxel uptake. An eccentric pattern is also
more amenable to balloon angioplasty compared to heavily calcified, concentric
disease. MLA and stent apposition are important for ischemia and procedural
complications but are not the primary predictors of DEB efficacy, which hinges on
tissue composition.
2. A 68-year-old woman with severe aortic stenosis (mean gradient 55 mmHg,
valve area 0.7 cm²) and symptomatic heart failure is referred for transcatheter
aortic valve replacement (TAVR). She has a history of peripheral artery disease and
a heavily calcified, tortuous iliofemoral system. Pre-procedural CT angiography
reveals an extremely small and calcified right femoral artery (4.5 mm) and a left
femoral artery (5.0 mm) with significant calcification. Which vascular access
strategy is associated with the lowest risk of major vascular complications in this
patient?
A) Bilateral femoral cutdown
B) Transapical approach using a sheathless system
C) Left femoral percutaneous approach with ultrasound-guided puncture and pre-
closure with two ProGlide devices
D) Subclavian artery approach
E) Direct aortic (transaortic) approach
Answer: D
,Rationale: In patients with hostile iliofemoral anatomy (calcified, small diameter
<5.5 mm), alternative access is preferred to minimize vascular complications. The
subclavian/axillary artery approach has been shown to have lower rates of major
bleeding and vascular injury compared to the transfemoral route in such high-risk
iliofemoral anatomies. While transapical and direct aortic are options, they carry
higher morbidity and mortality compared to subclavian. Sheathless systems can
reduce the sheath-to-artery ratio but do not eliminate the risk of calcific
embolization or rupture in small, calcified vessels. Percutaneous femoral access
with pre-closure is the standard for large vessels; in this case, the vessel size is
critically small.
3. A 55-year-old male with chronic kidney disease stage 3 and a large (4.2 cm)
abdominal aortic aneurysm (AAA) undergoes elective endovascular aneurysm
repair (EVAR). During the procedure, an aortogram shows a type IA endoleak.
What is the most appropriate immediate management step to secure the proximal
seal?
A) Observation with scheduled follow-up CT angiography in 1 month
B) Deployment of an aortic extender cuff (proximal cuff)
C) Balloon angioplasty of the proximal attachment site
D) Embolization of the aneurysm sac with coils
E) Conversion to open surgical repair
Answer: C
Rationale: A type IA endoleak occurs at the proximal attachment site. The first-
line, least invasive and most effective immediate maneuver is balloon angioplasty
of the proximal stent-graft to improve apposition against the aortic wall. If this
fails, the next step is often a proximal cuff. Open conversion is a bailout for rupture
or persistent failure, and embolization is for type II endoleaks. Observation is
inappropriate for a newly detected type IA endoleak as it increases sac pressure and
risk of rupture.
, 4. During a complex PCI for a chronic total occlusion (CTO) of the right coronary
artery, the guide catheter dissects the ostium of the left main coronary artery,
creating a large, flow-limiting intimal flap. The patient becomes hemodynamically
unstable. What is the most appropriate immediate intervention?
A) Administer intravenous vasopressors and observe
B) Balloon angioplasty of the left main to tack the flap
C) Emergent covered stent implantation in the left main
D) Urgent coronary artery bypass grafting (CABG)
E) Intravascular ultrasound (IVUS) to assess the flap
Answer: C
Rationale: An iatrogenic ostial left main dissection is a life-threatening emergency
that can rapidly lead to acute occlusion and cardiac arrest. The most definitive and
immediate percutaneous solution is the deployment of a covered stent to seal the
dissection flap and exclude the false lumen, restoring true lumen flow. Balloon
angioplasty alone can propagate the dissection. IVUS is useful but delays
definitive treatment in an unstable patient. CABG may be necessary if PCI fails,
but the immediate priority is to stabilize the patient with a covered stent.
5. A 74-year-old female with non-ischemic cardiomyopathy (LVEF 25%) and left
bundle branch block (LBBB) is referred for cardiac resynchronization therapy
(CRT). A transvenous left ventricular (LV) lead is attempted via the coronary sinus.
Despite multiple attempts, a suitable lateral or posterolateral vein cannot be
cannulated due to tortuosity and small caliber. Which of the following is the most
appropriate next step for achieving LV pacing?
A) Implant a single-chamber ICD only
B) Perform surgical epicardial lead placement
ACTUAL EXAM 2026-2027 COMPLETE ACCURATE EXAM
REAL QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES (100% RELIABLE ANSWERS)
CURRENTLY UPDATED VERSION EDITION 2026
|GUARANTEED PASS A+ (BRAND NEW!!) |INSTANT
DOWNLOAD PDF
1. A 72-year-old male with a history of non-ST-elevation myocardial infarction
(NSTEMI) three years ago, status post two drug-eluting stents (DES) to the left
anterior descending (LAD) artery, presents with recurrent exertional angina. He is
on aspirin, clopidogrel, atorvastatin, and metoprolol. Coronary angiography reveals
a 70% in-stent restenosis (ISR) at the proximal edge of the previously placed stent.
Intravascular ultrasound (IVUS) is performed. Which of the following IVUS
findings would most strongly predict a favorable long-term outcome following
percutaneous coronary intervention (PCI) with a drug-eluting balloon (DEB) for
this lesion?
A.A minimum lumen area (MLA) of 2.5 mm²
B.A prominent, eccentric, hypoechoic neointimal hyperplasia without significant
calcification
C.Incomplete stent apposition at the distal edge
D.A neoatherosclerotic, echogenic, superficial calcified nodule
E.An echodense, homogeneous, circumferential neointima
,Answer: B
Rationale: DEB therapy is most effective for ISR when the underlying mechanism
is predominantly neointimal hyperplasia, which appears as a hypoechoic (soft)
tissue. The presence of significant calcification (echogenic) or neoatherosclerosis
reduces drug transfer and efficacy. IVUS helps characterize the plaque; soft, non-
calcified lesions allow for better paclitaxel uptake. An eccentric pattern is also
more amenable to balloon angioplasty compared to heavily calcified, concentric
disease. MLA and stent apposition are important for ischemia and procedural
complications but are not the primary predictors of DEB efficacy, which hinges on
tissue composition.
2. A 68-year-old woman with severe aortic stenosis (mean gradient 55 mmHg,
valve area 0.7 cm²) and symptomatic heart failure is referred for transcatheter
aortic valve replacement (TAVR). She has a history of peripheral artery disease and
a heavily calcified, tortuous iliofemoral system. Pre-procedural CT angiography
reveals an extremely small and calcified right femoral artery (4.5 mm) and a left
femoral artery (5.0 mm) with significant calcification. Which vascular access
strategy is associated with the lowest risk of major vascular complications in this
patient?
A) Bilateral femoral cutdown
B) Transapical approach using a sheathless system
C) Left femoral percutaneous approach with ultrasound-guided puncture and pre-
closure with two ProGlide devices
D) Subclavian artery approach
E) Direct aortic (transaortic) approach
Answer: D
,Rationale: In patients with hostile iliofemoral anatomy (calcified, small diameter
<5.5 mm), alternative access is preferred to minimize vascular complications. The
subclavian/axillary artery approach has been shown to have lower rates of major
bleeding and vascular injury compared to the transfemoral route in such high-risk
iliofemoral anatomies. While transapical and direct aortic are options, they carry
higher morbidity and mortality compared to subclavian. Sheathless systems can
reduce the sheath-to-artery ratio but do not eliminate the risk of calcific
embolization or rupture in small, calcified vessels. Percutaneous femoral access
with pre-closure is the standard for large vessels; in this case, the vessel size is
critically small.
3. A 55-year-old male with chronic kidney disease stage 3 and a large (4.2 cm)
abdominal aortic aneurysm (AAA) undergoes elective endovascular aneurysm
repair (EVAR). During the procedure, an aortogram shows a type IA endoleak.
What is the most appropriate immediate management step to secure the proximal
seal?
A) Observation with scheduled follow-up CT angiography in 1 month
B) Deployment of an aortic extender cuff (proximal cuff)
C) Balloon angioplasty of the proximal attachment site
D) Embolization of the aneurysm sac with coils
E) Conversion to open surgical repair
Answer: C
Rationale: A type IA endoleak occurs at the proximal attachment site. The first-
line, least invasive and most effective immediate maneuver is balloon angioplasty
of the proximal stent-graft to improve apposition against the aortic wall. If this
fails, the next step is often a proximal cuff. Open conversion is a bailout for rupture
or persistent failure, and embolization is for type II endoleaks. Observation is
inappropriate for a newly detected type IA endoleak as it increases sac pressure and
risk of rupture.
, 4. During a complex PCI for a chronic total occlusion (CTO) of the right coronary
artery, the guide catheter dissects the ostium of the left main coronary artery,
creating a large, flow-limiting intimal flap. The patient becomes hemodynamically
unstable. What is the most appropriate immediate intervention?
A) Administer intravenous vasopressors and observe
B) Balloon angioplasty of the left main to tack the flap
C) Emergent covered stent implantation in the left main
D) Urgent coronary artery bypass grafting (CABG)
E) Intravascular ultrasound (IVUS) to assess the flap
Answer: C
Rationale: An iatrogenic ostial left main dissection is a life-threatening emergency
that can rapidly lead to acute occlusion and cardiac arrest. The most definitive and
immediate percutaneous solution is the deployment of a covered stent to seal the
dissection flap and exclude the false lumen, restoring true lumen flow. Balloon
angioplasty alone can propagate the dissection. IVUS is useful but delays
definitive treatment in an unstable patient. CABG may be necessary if PCI fails,
but the immediate priority is to stabilize the patient with a covered stent.
5. A 74-year-old female with non-ischemic cardiomyopathy (LVEF 25%) and left
bundle branch block (LBBB) is referred for cardiac resynchronization therapy
(CRT). A transvenous left ventricular (LV) lead is attempted via the coronary sinus.
Despite multiple attempts, a suitable lateral or posterolateral vein cannot be
cannulated due to tortuosity and small caliber. Which of the following is the most
appropriate next step for achieving LV pacing?
A) Implant a single-chamber ICD only
B) Perform surgical epicardial lead placement
