Table Of ContentMatthew P. Lungren
Michael R.B. Evans
Editors
The Interventional
Clinical Medicine
Cardiology Training
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Nick Curzen
Second Edition
Stephan Windecker
Paul A. Gurbel
Editors
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The Interventional Cardiology
Training Manual
Aung Myat • Sarah Clarke
Nick Curzen • Stephan Windecker
Paul A. Gurbel
Editors
The Interventional
Cardiology Training
Manual
Editors
Aung Myat Sarah Clarke
Brighton and Sussex Medical School Royal Papworth Hospital NHS
and the Sussex Cardiac Centre Foundation Trust
Brighton and Sussex University Papworth Everard
Hospitals NHS Trust Cambridge
Brighton UK
UK
Stephan Windecker
Nick Curzen Department of Cardiology
Wessex Cardiothoracic Centre Bern University Hospital
University Hospital Southampton NHS Bern
Foundation Trust Switzerland
Southampton
UK
Paul A. Gurbel
Inova Center for Thrombosis Research
and Drug Development
Inova Heart and Vascular Institute
Falls Church, VA
USA
ISBN 978-3-319-71633-6 ISBN 978-3-319-71635-0 (eBook)
https://doi.org/10.1007/978-3-319-71635-0
Library of Congress Control Number: 2018945487
© Springer International Publishing AG, part of Springer Nature 2018
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Foreword
It is with great pleasure that I introduce The Interventional Cardiology Training
Manual, co-edited by Drs. Myat, Clarke, Curzen, Windecker, and Gurbel.
Tailored to the needs of the cardiology fellow and junior consultants, this
is a welcome addition to the training literature. It combines a comprehensive
coverage of the curriculum with a very practical and concise presentation of
the individual topics.
Ever since the frst coronary angioplasty with a balloon catheter in 1977,
interventional cardiology has developed into a subspeciality that is defned by
increasingly sophisticated technology, improved pharmacological options,
and evidence-driven treatment strategies. Today’s interventional cardiologist
needs to have a good understanding of the underlying pathophysiology in
acute and chronic conditions, manage the medical strategies for patients,
master the different device technologies in the cath lab, and translate the ever
growing trial evidence and guideline recommendations into their clinical
practice. A compendium summarizing the most relevant information for
training and accreditation has been missing.
The present Interventional Cardiology Training Manual comprises 33 chap-
ters, all written by leading experts in the feld. A unique touch is that we get to
know about the professional background of the authors and the institutions they
represent at the beginning of each chapter. The topics are brought to life by
explaining the relevance for clinical practice, adding evidence and bullet point
lists for easy learning. All supported by excellent graphical illustrations and
clinical examples. This manual will serve equally as a learning platform and a
reference tool for quick consultation. I am sure it will become a standard work,
to be found on every interventional cardiology fellows’ shelf or computer.
Andreas Baumbach
Queen Mary University of London
and the Barts Heart Centre
London, UK
Yale School of Medicine
New Haven, CT, USA
European Association of
Percutaneous Cardiovascular Interventions (EAPCI)
Sophia Antipolis, France
v
Preface
The evolution of interventional cardiology has been rapid and unrelenting. We
owe a huge debt of gratitude to the founding fathers of our subspecialty:
Werner Forssmann, André Cournand, Dickinson Richards, Mason Sones,
Charles Dotter, Melvin Judkins, Andreas Gruentzig, Richard Schatz, Julio
Palmaz, Jacques Puel, and Ulrich Sigwart, to name but a few. These pioneers,
along with the many thousands of practising physicians and clinician scientists
past and present from across the world, have allowed interventional cardiology
to grow into the dynamic and evidence-rich feld of medicine that it is today.
Interventional cardiology incorporates a requirement for both technical and
decision-making skillsets. It demands consistently high personal and profes-
sional standards to provide optimal care and offers frequent opportunities to
provide life-saving and life-modifying therapy. We have tried to encapsulate the
very essence of this ethos into The Interventional Cardiology Training Manual.
Our aim has been to create a readily accessible educational tool for all fellows
undertaking subspecialty training in interventional cardiology. The text will also
serve as a refresher to early-career consultant (attendings in) interventional car-
diologists. The key objective is to equip the reader with an expert-led guideline-
mandated resource to be used as an aide-mémoire focused primarily on
preprocedural planning of, periprocedural decision-making during, and the
salient technical aspects of coronary intervention so that it is performed safely,
appropriately, effectively, and with reference to the evidence base. The intention
was not to produce a comprehensive reference text. The intention has been to
produce a book that an interventional cardiologist can use to solidify their thera-
peutic thought process in the emergency room, the coronary care unit, or the
catheterization laboratory so that the best possible care can be given to patients.
Each chapter covers a specifc aspect of interventional cardiology, written by
authors from leading cardiac centers across Europe, the United States, and Asia.
Uniquely, each chapter has been written in a center-specifc manner, affording the
reader an opportunity to learn how each individual center performs a specifc
procedure, which algorithms and guidelines they follow, and what evidence they
utilize to optimize patient outcome. To that end, we thank wholeheartedly all our
contributors for their enthusiasm, wisdom, diligence, and attention to detail.
We very much hope you enjoy reading this book. We very much hope read-
ing this book will help to improve and consolidate your clinical practice.
Brighton, UK Aung Myat
vii
Contents
1 C oronary Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Diana Gorog
2 C linical Assessment of Coronary Heart Disease . . . . . . . . . . . . 13
Evangelos Giannitsis and Hugo A. Katus
3 N oninvasive Imaging Assessment of Coronary
Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Udo Sechtem, Heiko Mahrholdt, and Peter Ong
4 L eft Heart Catheterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Satpal Arri and Brian Clapp
5 V ascular Access for Left Heart Catheterization . . . . . . . . . . . . . 59
Aditya Mandawat and Sunil V. Rao
6 R ight Heart Catheterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Jean-Luc Vachiéry and Céline Dewachter
7 R adiation Exposure and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Kully Sandhu, Gurbir Bhatia, and James Nolan
8 P lanning Coronary Intervention: The “Golden
Rules”—Patient Checklist and Troubleshooting . . . . . . . . . . . . 103
Sergio Buccheri and Davide Capodanno
9 G uide Catheters: Selection, Support, Extension and Guide
Wire Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Murugapathy Veerasamy and Nicholas D. Palmer
1 0 B alloon Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
George A. Stouffer
1 1 S tent Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Raffaele Piccolo and Stephan Windecker
1 2 P ercutaneous Coronary Intervention:
Adjunctive Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Paul A. Gurbel and Udaya S. Tantry
1 3 A djunctive Technologies (Rotablation, Excimer Laser,
Aspiration Thrombectomy, Distal Embolic Protection) . . . . . . 181
Michael S. Lee and Jeremy Kong
ix
x Contents
1 4 I ntracoronary Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Takashi Kubo and Takashi Akasaka
1 5 P hysiologic Lesion Assessment: Fractional Flow Reserve . . . . . 211
Mohammad Sahebjalal and Nicholas Curzen
1 6 P rimary Percutaneous Coronary Intervention
for ST-Elevation Myocardial Infarction . . . . . . . . . . . . . . . . . . . 229
Lene Holmvang and Francis R. Joshi
1 7 P ercutaneous Coronary Interventions
for NSTEMI and Unstable Angina . . . . . . . . . . . . . . . . . . . . . . . 245
Stéphane Noble and Marco Roff
1 8 P ercutaneous Coronary Intervention for Stable
Ischemic Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
William S. Weintraub, Sandra Weiss, and Abdul Latif Bikak
1 9 P ercutaneous Coronary Intervention for Left
Ventricular Systolic Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . 263
Sophie Zhaotao Gu, Amr Gamal, Christopher Eggett, Hani
Ali, Azfar Zaman, Richard Edwards, and Vijay Kunadian
2 0 P ercutaneous Coronary Intervention: Special
Considerations in Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Lucy Blows and Timothy Williams
2 1 C oronary Intervention in the Chronic Kidney
Disease, Diabetic and Elderly Populations . . . . . . . . . . . . . . . . . 291
Sami Omar, Osama Alsanjari, and Adam de Belder
2 2 S tent Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Javier Cuesta, Marcos García-Guimaraes, Fernando Rivero,
Teresa Bastante, and Fernando Alfonso
2 3 C ardiogenic Shock and Mechanical Circulatory Support . . . . 315
Stephen P. Hoole and Alain Vuylsteke
2 4 O ut-of-Hospital Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Ian Webb, Rafal Dworakowski, and Philip MacCarthy
2 5 M echanical Complications of Acute
Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Andras Peter Durko, Wouter Jacob van Leeuwen,
and Arie Pieter Kappetein
2 6 C ontemporary Treatment of Coronary
Bifurcation Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
James Cockburn, Osama Alsanjari, and David Hildick-Smith
2 7 L eft Main Coronary Artery Intervention . . . . . . . . . . . . . . . . . . 373
Giovanni Luigi De Maria and Adrian Paul Banning
2 8 C hronic Total Occlusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Rohit Sirohi, Amerjeet Banning, and Anthony H. Gershlick
Contents xi
2 9 M ultivessel Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . 431
Mina Owlia and Sripal Bangalore
3 0 S econdary Percutaneous Revascularization
After Coronary Artery Bypass Graft Surgery . . . . . . . . . . . . . . 449
Jean Paul Vilchez-Tschischke, Hernán David Mejía-Rentería,
Nieves Gonzalo, Philip Francis Dingli, Pablo Salinas,
and Javier Escaned
3 1 I n-Stent Restenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Roisin Colleran and Robert A. Byrne
3 2 P ercutaneous Coronary Intervention:
Management of Complications . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Robert T. Gerber, Athanasios Kosovitsas, and Carlo Di Mario
3 3 B leeding Associated with Angiography and Percutaneous
Coronary Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Serdar Farhan, Usman Baber, and Roxana Mehran
I ndex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
Coronary Heart Disease
1
Diana Gorog
About Us The National Heart and Lung Institute • The predominant cause of cardiovascular
of Imperial College, based in South Kensington, death is ischemic heart disease, for both men
London, is recognized for its excellence in cardio- and women. Advancing age is the strongest
vascular research both nationally and internation- risk factor.
ally, in both basic science and translational research. • Global CVD rates rose by 12.5% between 2005
Professor Diana Gorog is a Consultant and 2015, with deaths attributable to ischemic
Cardiologist with an interest in coronary interven- heart disease (IHD) increasing by 16.6% to 8.9
tion and research interest in coronary thrombosis. million deaths. Over the same time period, age-
She has been Clinical Director of Cardiology for standardized mortality rates for IHD fell by
the last 8 years and currently Clinical Director of 12.8%, refecting improved survival of patients.
Research at East and North Hertfordshire NHS • Recent data from the Offce for National
Trust, Professor of Cardiovascular Medicine Statistics in 2015 show that in England and
at the University of Hertfordshire and Visiting Wales, more people now die from dementia than
Professor at Imperial College. Based just out- heart disease, with dementia being the leading
side north London, the Trust comprises 4 hos- cause of death in women, although IHD contin-
pitals, with a large catchment area of some ues to be the leading cause of death in men.
700,000 patients and 24/7 PPCI is provided at the • There is, therefore, an important ongoing need
720-bedded Lister Hospital. to further reduce mortality and morbidity from
IHD, and an appreciation of the pathophysiol-
ogy of IHD is essential to enable this.
I ntroduction
• Globally, cardiovascular disease (CVD) remains P athophysiology
the leading cause of mortality and morbidity,
despite many preventative and therapeutic A therosclerosis
advances. CVD accounted for some 18 million
deaths worldwide in 2015, and this number is R isk Factors for Development
expected to grow to >23.6 million by 2030. of Coronary Artery Disease
• Both genetic and environmental factors con-
D. Gorog tribute to the development of coronary athero-
National Heart and Lung Institute, Imperial College sclerosis. Genome-wide association studies
London, London, UK have revealed more than 55 loci related to
e-mail:
