When should PCI be performed?

  1. Risks vs benefits

  2. Benefits

    1. Symptoms

    2. Death

    3. MI

    4. Repeat revascularization

  3. Risks

    1. Acute

    2. Chronic

  4. Guidelines

 

THE BASICS

  1. Equipment

    1. Catheters

    2. Wires

    3. Microcatheters

    4. Balloons

    5. Stents

    6. Snares

    7. Hemodynamic support

  2. Access

    1. Radial

    2. Femoral  

  3. Catheter engagement

    1. Diagnostic angiography

    2. Guides

    3. Guide extensions

  4. Angiography

  5. Wiring

  6. Lesion assessment

  7. Coronary physiology

    1. FFR

    2. Resting indices

  8. Coronary imaging

    1. IVUS

    2. OCT

  9. Lesion preparation

    1. Balloon angioplasty

    2. Modified balloons

    3. Atherectomy

    4. Thrombectomy

    5. Laser

    6. Lithoplasty

  10. Stenting

    1. Stent delivery

    2. Stent deployment

    3. Stent optimization

  11. Adjunctive pharmacotherapy

    1. Before

    2. During

    3. After PCI

  12. Hemodynamic support

COMPLEX SUBGROUPS

  1. Tortuosity

  2. Calcification

  3. Ostial lesions

  4. Bifurcations

  5. Thrombus – ACS lesions

  6. Multivessel disease

  7. Small vessels

  8. Saphenous vein grafts

  9. Arterial grafts

  10. Left main

  11. Coronary aneurysms

  12. Balloon uncrossable and undilatable

  13. In-stent restenosis

  14. Cardiogenic shock

  15. Long lesions

  16. SCAD

COMPLICATIONS

  1. Acute closure

    1. Dissection

    2. Embolization

    3. No reflow

    4. Pseudolesion

  2. Perforation

    1. Large vessel

    2. Distal perforation

  3. Equipment loss/entrapment

  4. Myocardial infarction

  5. Tamponade

  6. Arrhythmias

  7. Contrast nephropathy

  8. Radiation-related injury