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This handbook is intended for all practicing physicians within the field of interventional cardiology, with an emphasis placed upon practical technical and clinical considerations for percutaneous coronary intervention (PCI). We hope that this resource written and edited by members from within the American College of Cardiology may prove useful to all practitioners – from fellows-in-training to early career practitioners to experienced senior operators. This initiative was conceived, designed, and endorsed by the Interventional Section Leadership Council.
In developing this resource, our goal was to provide a single source of introductory information on percutaneous coronary intervention – from radial access strategies to intravascular imaging to techniques in left main stenting. We placed an emphasis on practical step-by-step technical considerations for PCI where appropriate, but also incorporated other pragmatic topics such as appropriate use criteria and employment of the multidisciplinary Heart Team.
We hope that this handbook will provide the reader with an overview of both clinical and technical fundamentals in the field of coronary intervention. As both technologies and practice standards evolve, so too will the contents of this handbook. We acknowledge that this resource may be used broadly, and anticipate that there may be content areas that physicians may wish to revise and expand upon in any future iterations.
We welcome your comments, edits, and suggestions and ask that you please email our copy editor, Abby Cestoni (acestoni@acc.org) with any suggestions. We would like to acknowledge the contributions of our editorial staff team, authors, and content reviewers for which this publication would not have been possible as well as the support of the American College of Cardiology and its Interventional Section Leadership Council.
Michael N. Young, MD, RPVI
Frederick Welt, MD, FACC
Roxana Mehran, MD, FACC
Handbook Editorial Team
Chief Editor
Michael N. Young, MD, RPVI
Assistant Professor of Medicine
Geisel School of Medicine
Dartmouth-Hitchcock Medical Center
Senior Editors
Frederick Welt, MD, FACC
Chair, Interventional Section Leadership Council (2019-2022)
Margaret Amundsen Professor of Cardiology
Vice Chair, Clinical Affairs, Dept. of Medicine
Associate Chief, Division of Cardiovascular Medicine
Director, Cardiac Catheterization Laboratory
University of Utah Health Sciences Center
Roxana Mehran, MD, FACC
Chair, Interventional Section Leadership Council (2016-2019)
Professor of Medicine, Cardiology
Professor of Population Health Science and Policy
Director of Interventional Cardiovascular Research and Clinical Trials
Icahn School of Medicine at Mount Sinai
Copy Editors
Abby B. Cestoni
American College of Cardiology, Washington, DC
Jennifer Frampton, DO, MPH
Dineth Bandarage, MD
Disclaimer and Copyright Information
Disclaimer
The Coronary Interventions Handbook is an overview document developed by the ACC's Interventional Member Section. The material presented herein in this handbook is, to the best of our knowledge, accurate and factual to date at the time of publication and has undergone peer review. The information is provided as a basic overview for coronary interventions and should be used as an adjunct to other educational texts, journal articles, and clinical experiences. The field of coronary interventions is rapidly evolving, therefore, this work is presented "as is" and the publisher disclaims any and all warranties, express or implied, including any warranties as to the accuracy, comprehensiveness, or currency of this work. This resource is no substitute for individual patient assessment based on a healthcare professional's evaluation of each patient. The publisher does not provide medical advice or guidance and this text is a merely a reference tool. Healthcare professionals are solely responsible for use of this work and ultimately all medical judgements and resulting diagnoses and treatments.
All rights reserved
This book is protected by copyright by the American College of Cardiology. No part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying or the use of any information storage and retrieval system without written permission from the American College of Cardiology.
Copyright ©2020 by the American College of Cardiology, Washington, DC
Content Reviewers
Ehrin Armstrong, MDx, FACC
Herbert Aronow, MDx, MPH, FACC
Megan Coylewright, MD, MPH
Prashant Kaul, MD, FACC
Roxana Mehran, MD, FACC
S. Tanveer Rab, MBBS, FACC
Behnam Tehrani, MD, FACC
Alexander Truesdell, MD, FACC
George Vetrovec, MD, MACC
Frederick Welt, MD, FACC
Janet Wyman, DNP, FACC
Michael N. Young, MD
Table of Contents
CHAPTER 1 | Coronary Wiring Fundamentals: Wire Design, Engineering and Selection
Bina Ahmed, MD, FACC
CHAPTER 2 | Radial/Ulnar Arterial Access Considerations: Step-by-Step, Troubleshooting, and Tips-and-Tricks
Guillaume Marquis-Gravel MD, MSc, Sunil V Rao, MD, FACC
CHAPTER 3 | Femoral Arterial Access Considerations: Step-by-Step Troubleshooting, and Tip-and-Tricks
Karim Al-Azizi, MD, FACC, Molly Szerlip, MD, FACC
CHAPTER 4 | Antiplatelet Strategies in Percutaneous Coronary Interventions: Selection, Duration and Considerations
Usman A. Tahir, MD, Robert W. Yeh MD, MSc, FACC
CHAPTER 5 | Physiological Assessment of Coronary Lesions
Akl C. Fahed, MD, MPH, Sammy Elmariah, MD, MPH, FACC
CHAPTER 6 | Step-by-Step on Lesion Preparation and Atherectomy
Gautam Kumar, MD, FACC, Anbukarasi Maran, MBBS, FACC
CHAPTER 7 | Left Main Interventions
Supawat Ratanapo, MD, FACC, S. Tanveer Rab, MBBS, FACC
CHAPTER 8 | Challenges, Pitfalls, and Step-by-Step Techniques for Treating In-Stent Restenosis
Jodie L. Kenes, MD, FACC, David X.M. Zhao, MD, FACC
CHAPTER 9 | Retrograde Chronic Total Occlusions
Brian Bergmark, MD, FACC, Kevin Croce, MD, PhD
CHAPTER 10 | Considerations and Step-by-Step Approaches to Bifurcation Stenting
Jennifer Frampton, DO, MPH, Eric Rothstein MD, Aaron V. Kaplan MD, FACC
CHAPTER 11 | Overview, Indications, and Step-by-Step Techniques for Hemodynamic Support Devices
Vimalkumar Veerappan Kandasamy, MBBS, FACC, Anub G. John, MBBS, FACC, Vikas Singh, MD
CHAPTER 12 | Intracoronary Imaging-I: Step-by-Step Technique for Intravascular Ultrasound (IVUS)
Poonam Velagapudi, MD, MS, FACC, J. Dawn Abbott, MD, FACC
CHAPTER 13 | Step-by-Step Approach to Intracoronary Imaging-II: Optical Coherence Tomography (OCT)
Eyal Ben-Assa, MD, Michael N. Young, MD, Ik-Kyung Jang, MD, PhD, FACC
CHAPTER 14 | Step-by-Step Guide to Femoral Vascular Access Closure: Devices and Technical Considerations
David W. Allen, MD, FRCPC, Prashant Kaul, MD, FACC
CHAPTER 15 | Management of Complications in Complex Coronary Interventions
Peter Tajti, MD, Iosif Xenogiannis, MD, M. Nicholas Burke, MD, Imre Ungi, MD, Emmanouil S. Brilakis, MD, PhD, FACC
CHAPTER 16 | Appropriate Use Criteria for Revascularization
Lloyd W. Klein, MD, FACC, Enrique Padilla Campos, MD
CHAPTER 17 | Workflow and Deployment of the Multidisciplinary Heart Team Model in the Management of Complex Coronary Artery Disease
Ada C. Stefanescu Schmidt, MD, MSc, Farouc A. Jaffer, MD, PhD, FACC
CHAPTER 18 | Educational Curriculum, Milestones, and ACC Resources for the Interventional Cardiology Fellow-in-Training
Sara M. Negrotto, MD, Julie B. Damp, MD, FACC, John A. McPherson, MD, FACC, Lisa A. Mendes, MD, FACC
