Management of Percutaneous Coronary Intervention Complications

Abstract

Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.

Association between Illness Perception and Anxiety Undergoing Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Pilot Study

“…The previous study showed that 24-72% of patients who will undergo PCI tend to experience anxiety symptoms [5]. The symptoms of patients' anxiety include excessive fear of the therapeutic procedure, feelings of tension, fear of uncertainty about the disease, feeling excessive pain, and excessive worrying before patients undergo PCI [6].…”

Complications in Cath Lab – how to bail out

“…In longer dissections, initial stenting of the distal margin is warranted to prevent downstream propagation. 9 Maintenance of the guidewire in the true lumen is critical. If guidewire position is lost and the true lumen cannot be regained by advancing a spring-coil wire (favored over polymer-jacketed guidewires), antegrade dissection-re-entry may be considered.…”

“…If guidewire position is lost and the true lumen cannot be regained by advancing a spring-coil wire (favored over polymer-jacketed guidewires), antegrade dissection-re-entry may be considered. 9 Retrograde wiring may facilitate anterograde stenting. 8 Emergency coronary artery bypass graft surgery is required when these methods fail.…”

Diagnostic performance of IVUS-FFR analysis based on generative adversarial network and bifurcation fractal law for assessing myocardial ischemia

“…The clinical feasibility of performing both IVUS and invasive FFR on the same patient is low. Both IVUS and invasive FFR are interventional exams with the traits of being high risk and requiring a lot from the operator ( 7 , 8 ). Performing IVUS and invasive FFR at the same time will prolong the operation time and increase the risk of surgery.…”