Complex percutaneous coronary intervention (PCI) has helped patients for decades. It was a revolutionary technique when it was initially developed by Andreas Gruntzig in the late ’70s. It replaced traditional surgery in patients who suffered from simple, single or double vessel lesions, resulting in a much quicker recovery.
Over the years the method was improved, and, with the advent of stents (metal scaffolds) and later medicated stents, the chance of disease recurrence decreased significantly.
However, certain lesions continued to prove difficult to treat in a safe manner using standard PCI techniques. In these cases a patient’s only option remained surgery or medical therapy, if they were deemed high risk for surgery. In the latter case many patients had to live with life-limiting symptoms.
Lesions found to be difficult or less safe to treat by regular PCI include:
- Heavily calcified lesions
- Left main interventions
- Bifurcation lesions
- Heavily angulated lesions
- Chronic Total Occlusion (CTO)
- Lesions in patients with poor heart function
Fortunately, many transcatheter techniques and devices have been developed in the past decade to address complex PCI, which, in experienced hands, are making it safe to treat these patients.
Some of these devices are as simple as specialty wires and catheters to navigate difficult lesions, though also include new atherectomy devices to shave the calcium, as well as devices to give hemodynamic support during the case.
Nevertheless, the physician must be familiar with these devices and techniques to make the procedure effective and safe for patients.
Dr. Yazdani has been in the forefront of introducing complex PCI techniques to northern Virginia. He was the director of the Complex PCI & CTO program at Inova Heart and Vascular Institute from 2015- 2018, when he decided to return to private practice. He continues to perform complex PCI routinely, helping many patients who would otherwise have limited options.