Advanced Percutaneous Coronary Intervention Techniques

Lesson 1 • Hemodynamic Monitoring Fundamentals

Introduces pressure waveform interpretation, cardiac output measurement, and hemodynamic instability recognition. Prepares operators to monitor and respond to intra-procedural hemodynamic changes.

Lesson 2 • Coronary Microvascular Physiology

Examines autoregulation, coronary flow reserve, and microvascular resistance. Links physiologic concepts to functional lesion severity assessment used throughout the course.

Lesson 3 • Atherosclerotic Plaque Pathophysiology

Describes plaque formation, vulnerability markers, and calcification patterns. Grounds lesion classification and intervention strategy selection in pathophysiologic reality.

Lesson 1 • Radial Access Technique and Optimization

Teaches Allen test assessment, radial artery puncture, and hydrophilic sheath insertion. Radial access is the dominant approach and underpins safe guide catheter delivery.

Lesson 2 • Guide Catheter Selection and Engagement

Addresses catheter curve selection for varied aortic root geometries and ostial engagement techniques. Proper guide selection directly determines support and deliverability of interventional equipment.

Lesson 3 • Anticoagulation and Pharmacology at Access

Reviews heparin dosing, bivalirudin protocols, and ACT monitoring during access and sheath management. Establishes anticoagulation principles applied throughout all subsequent procedural chapters.

Lesson 1 • Angiographic Projection Optimization

Teaches standard and orthogonal projections for each coronary territory to minimize foreshortening and overlap. Optimal projections are prerequisite to accurate lesion measurement and wire navigation.

Lesson 2 • Quantitative Coronary Angiography

Covers reference diameter selection, percent stenosis calculation, and lesion length measurement. QCA data directly informs stent sizing and procedural planning in subsequent chapters.

Lesson 3 • Instantaneous Wave-Free Ratio Assessment

Introduces iFR acquisition, wave-free period physiology, and co-registration with angiography. Provides a resting-state alternative to FFR for operators trained in pressure-wire physiology.

Lesson 4 • Fractional Flow Reserve and Pressure Wire Use

Explains FFR measurement technique, adenosine administration, and decision thresholds for intermediate lesions. Physiologic assessment complements angiographic data for revascularization decisions.

Lesson 1 • Bifurcation Wire Strategies

Covers jailing, rewiring, and side-branch wire protection techniques for bifurcation lesions. Wire strategy selection directly determines bifurcation stenting outcomes covered in later chapters.

Lesson 2 • Guidewire Design and Performance Properties

Examines tip load, torque transmission, support, and coating characteristics of contemporary wires. Wire property knowledge is the foundation for matching wire choice to lesion anatomy.

Lesson 3 • Guidewire Complications and Management

Addresses wire perforation, entrapment, fracture, and retrieval strategies. Early recognition and structured response prevent escalation to major adverse events.

Lesson 1 • Scoring and Cutting Balloon Techniques

Explains scoring wire and cutting blade mechanisms for fibrotic and resistant lesions. These devices extend lesion preparation capability beyond standard balloon angioplasty.

Lesson 2 • Inflation Technique and Pressure Management

Covers nominal and rated burst pressures, inflation duration, and staged dilation protocols. Controlled inflation technique prevents dissection and ensures uniform lesion modification.

Lesson 3 • Balloon Catheter Types and Selection

Compares compliant, semi-compliant, and non-compliant balloon properties and sizing principles. Correct balloon selection for each lesion type is prerequisite to safe and effective preparation.

Lesson 4 • Intravascular Lithotripsy for Calcification

Introduces shockwave catheter mechanism, sizing, and calcium modification protocols. IVL enables stent expansion in severely calcified lesions where conventional balloons fail.

Lesson 1 • Imaging-Guided Stent Sizing and Landing

Applies IVUS and OCT measurements to stent diameter selection, landing zone identification, and edge reference selection. Imaging-guided sizing reduces underexpansion and geographic miss.

Lesson 2 • Post-PCI Imaging Optimization Criteria

Defines imaging endpoints for stent expansion, apposition, and edge integrity after deployment. Systematic post-PCI imaging review drives targeted re-intervention before case completion.

Lesson 3 • OCT Image Acquisition and Interpretation

Explains OCT flush technique, pullback speed, and high-resolution tissue characterization. OCT's superior resolution enables detection of thin-cap fibroatheroma and stent malapposition.

Lesson 4 • IVUS Measurements and Stent Optimization

Teaches lumen area, plaque burden, and minimum stent area measurement with established optimization criteria. IVUS-defined MSA targets are directly linked to reduced MACE in clinical evidence.

Lesson 1 • Long Lesion and Overlapping Stent Strategy

Addresses stent overlap zone management, sequential deployment order, and gap prevention in long lesions. Overlap technique directly affects restenosis risk and DAPT duration decisions.

Lesson 2 • Ostial Lesion Stenting Techniques

Teaches aorto-ostial and branch-ostial stenting with precise positioning and flaring techniques. Ostial stenting demands unique catheter management and stent positioning discipline.

Lesson 3 • Stent Deployment and Post-Dilation

Covers deployment pressure selection, post-dilation balloon sizing, and high-pressure optimization technique. Systematic post-dilation is the primary modifiable determinant of stent underexpansion.

Lesson 4 • Stent Thrombosis Prevention and DAPT

Reviews stent thrombosis risk factors, dual antiplatelet therapy duration, and platelet function testing. Pharmacologic optimization after stenting is integral to procedural success.

Lesson 1 • Rotational and Orbital Atherectomy

Explains burr sizing, speed selection, and run duration for rotational atherectomy in calcified lesions. Atherectomy enables stent delivery and expansion when balloon preparation is insufficient.

Lesson 2 • Bifurcation PCI Strategies

Compares provisional single-stent and two-stent techniques with evidence-based selection criteria. Bifurcation strategy choice is the primary determinant of side-branch patency and restenosis.

Lesson 3 • Left Main PCI Planning and Execution

Covers left main lesion assessment, imaging-guided sizing, and ostial versus distal bifurcation strategies. Left main PCI demands the highest technical precision and multidisciplinary planning.

Lesson 4 • Chronic Total Occlusion PCI Techniques

Introduces antegrade wire escalation, dissection re-entry, and retrograde approaches for CTO recanalization. CTO PCI requires dedicated equipment, dual access, and structured algorithmic decision-making.

Lesson 5 • No-Reflow and Slow-Flow Management

Addresses pathophysiology, pharmacologic treatment, and prevention strategies for no-reflow after PCI. Rapid recognition and treatment of no-reflow limits myocardial injury and improves outcomes.