Complex PCI procedures: challenges for the interventional cardiologist.

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Increasing prevalence of multivessel disease and complex coronary stenoses, especially in elderly patients ineligible for surgical revascularization.
• Growing number of patients with significant comorbidities referred for percutaneous coronary intervention (PCI).
• Complex patient profiles include multivessel, bifurcation, left main disease, calcified/tortuous vessels, degenerated grafts, and thrombotic lesions, associated with poorer outcomes.

Purpose of the Study:

• To provide an overview of complex PCI definitions and strategies for decision-making in challenging patient populations.
• To address the lack of robust evidence for revascularization strategies in patients with complex coronary anatomy.
• To offer guidance on complication prevention and post-interventional medical therapy.

Main Methods:

• Review of current literature and clinical practices regarding complex percutaneous coronary intervention (PCI).
• Discussion of decision-making frameworks for revascularization strategies in complex coronary artery disease.
• Overview of post-procedural medical management.

Main Results:

• Complex PCI is increasingly performed in a growing, yet understudied, patient population.
• Current decision-making relies heavily on experience and patient preference due to limited evidence.
• Specific lesion complexities are linked to reduced procedural success and increased adverse events.

Conclusions:

• There is a critical need for evidence-based guidelines for managing complex coronary artery disease.
• This article aims to bridge the knowledge gap by defining complex PCI and outlining management strategies.
• Optimizing outcomes requires careful consideration of revascularization options and post-PCI care.