An introductory discussion on who needs PCI-merits, demerits, scope and future.
Unique chapter on difficult subsets introduce methodology for tackling such situations with dynamic algorithms and illustrations.
Comprehensive coverage on prerequisites, equipment, modern imaging techniques, drugs and stents aiding the purpose of an interventional cardiologist.
Short discussion on structural and congenital heart diseases, and their scope in Cath lab.
Helpful for those who want to start intervention as a fellow or an independent operator, as well as the people in Cath lab, like technicians and nurses.

Table of Contents:
Chapter 1. Who Needs PCI 1 Soumitra Kumar • Case Selection—A Practical Approach 3 – Appropriateness of Coronary Intervention 4 – Appropriate Indications for Pci in Chronic Coronary Artery Disease 4 – Methods of Revascularization of Advanced Cad 7 – Appropriateness of Pci in Acs Setting 8 Chapter 2. PCI—Work Station 9 Sabyasachi Mitra, Shuvanan Ray • eGFR Calculation and prevention of Contrastinduced nephropathy 10 – In Simpler Calculations 11 – Prevention of CIN 11 – Sodium bicarbonate preparation 12 – Hemodialysis and hemofiltration 12 • Bleeding 13 – Bleeding Scores 13 – Strategies to reduce bleeding risk 14 • Syntax and Clinical Syntax Score 14 – Clinical Syntax Score 15 • A few words about Consent 16 – Diabetic Patients before PCI 16 • Post-procedure Care 18 • Events after Pci 19 Chapter 3. Access 22 Shuvanan Ray • Why Radial? 22 – Femoral access 23 – How you locate the common femoral artery 23 – How to perform a proper puncture 24 – Radial Access: Patient selection 25 – Patient Preparation 25 – Radial Access: Trouble shooting 26 – Radial cocktail and radial spasm 29 Chapter 4. Hemodynamics in Cathlab 30 Shuvanan Ray – How you Formulate Hemodynamic Worksheet 30 – Axioms Derived from Pressure Tracing 32 – Measurement of Cardiac Output 32 – Use of hemodynamic calculations in Cathlab 34 – Calculation of R-L and bidirectional shunt 36 – Calculation of Valve Areas 36 Chapter. 5. Radiographic Views 40 Shuvanan Ray • Purpose of angiography before PCI is to delineate 40 • How to start Coronary visualization 40 xviii Tips and Tricks in Interventional Cardiology – Angiography for Post-coronary Artery Bypass Grafting (CABG) patients 43 – Coronary lesions for PCI 43 – A few words about Coronary calcification 44 – Angiographic TIMI Classification of blood flow 45 – Angiographic classification of collateral flow 46 Chapter 6. Guide Catheters 48 Shuvanan Ray • Guide Catheter 48 • Depending on support, Guide catheters are classified 49 – Active support 49 – Passive support 49 – Balanced support 49 – Basic shapes of Guide catheters 50 – Basic Guiding Catheter selection 50 – Guide catheter manipulation from radial access 53 – Deep Throttling 54 Chapter 7. Guidewires 56 Shuvanan Ray • Structure of guidewire 56 – Special situations 60 – Re-entering a stent 61 • Complications of Guidewires 61 Chapter 8. Balloons—The Balloon Catheters 63 Shuvanan Ray – Properties of balloon catheter: A few words 63 – Inflation and deflation time 64 – Nominal and rated burst pressures 66 – Cutting and Scoring balloons 66 – Selection of Balloon Catheter 66 Chapter 9. Drug Eluting Stents 69 David Rozario – Drug Reservoir Technology 69 – Anti-proliferative Agents 70 • Limus Analogs 70 • Taxanes 70 – Drug Eluting Stent Platforms 70 • EES vs PES 72 • EES vs SES 73 – Zotarolimus eluting endeavor stent 73 • Endeavor Resolute Stent 73 • Biodegradable Polymers 73 – BIOMATRIX Stent (Biosensors International Pte Ltd, Singapore) 74 – NOBORI Stent (Terumo, Japan) 74 – The Combo Stent Platform (Orbusneich, Fort Lauderdate, USA) 74 – The ISAR TEST 4 Stent Platform 74 – FIREHAWK Stent (MicroPort Medical Shanghai, China) 75 – MyStent (Micell Technologies, Durham, NC, USA) 75 – SYNERGY Stent (Boston Scientific, Natick, MA, USA) 75 – YUKON-Sirolimus Eluting Stent 75 – BIOFREEDOM Biolimus A9 Eluting Stent 75 Contents xix – DES with durable polymers vs Biodegradable polymers vs Polymer-free DES 76 – Platinum Chromium DES 76 – NOVEL Stent Coatings 76 • Bioresorbable Vascular Scaffolds 77 Chapter 10. Non-angiographic Lesion Assessment 78 Shuvanan Ray • Fractional Flow Reserve (FFR) 78 – Technique of Fractional Flow Reserve 80 – IC Adenosine vs IV Adenosine for Fractional Flow Reserve 80 – Clinical Use of Fractional Flow Reserve 81 – Instantaneous Wave-free Ratio (IFR) 81 – Intravascular Imaging (IVUS, OCT) 82 • IVUS 82 – IVUS Measurement in Practice 83 – Plaque Morphology 84 • Assessing PCI 84 – Optical Coherence Tomography (OCT) 87 • Summary of Recommendation [SCAI 2011] 87 – Fractional Flow Reserve (FFR) 87 – Intravascular Ultrasound (IVUS) 88 – Optical Coherence Tomography (OCT) 88 Chapter 11. Drugs used in Cathlab 89 Siddhartha Bandyopadhyay • Antiplatelet agents 89 • Cyclooxygenase Inhibitor 89 • Adp Receptor Antagonist 89 • Clopidogrel 90 • Prasugrel 90 • Ticagrelor 90 • Recommendations 90 • Antiplatelet Therapy after stenting 91 – Intravenous Glycoprotein IIbIIIa inhibitors 91 • Abciximab 91 • Eptifibatide 91 • Tirofiban 91 – Recommendations 92 – Anticoagulant therapy 92 • Recommendations 93 • No Reflow Phenomenon 94 – Management 94 – Vasoactive Drugs in Cathlab 95 • Hypotension during PCI 99 Chapter 12. Difficult Subsets 101 Shuvanan Ray • Bifurcation Stenosis PCI 101 – Anatomy and classification 101 • Techniques 102 – Stenting procedures 103 – Elective double stenting 104 – Individual techniques 105 – Specific issues in SKS 105 – Specific issues in Mini crush and DK crush 107 xx Tips and Tricks in Interventional Cardiology – Culotte Stenting 107 – Bifurcation Stenting: Summary 109 • Ostial Lesions 109 – Methods 110 – Difficulty in stent tracking 115 – Buddy in Jail technique 116 – Anchor Balloon technique 117 – Balloon Deflation technique 117 – Rotablation: Tips and tricks 119 – Plaque modification vs debulking 119 – Brief description of the equipment 119 – Other hardware 121 • Steps of Rotablation 123 – Steps of CTO Intervention—the basics 127 • Hardwares for CTO Intervention 127 – Microcatheters 127 – Guidewires for CTO 129 – Special CTO Wires 129 • Summary 130 – Other techniques 130 – Special situations 131 – Acute Myocardial Infarction 135 – Manual Thrombosuction catheters 135 – Large bulky thrombus 136 – A few words about SVG Angioplasty 139 – Technical issues 140 Chapter 13. Structural Heart Disease 142 Shuvanan Ray • Mitral Balloon Valvuloplasty 142 – Contraindications to BMV 144 – The Inoue Balloon catheter 144 – Sizing of the balloon 144 – Balloon Preparation 145 – Steps of Septal Puncture 147 – Few areas of trouble 148 – Alternate loop Method 150 • Accordian Maneuver 150 – Post-procedure evaluation and balloon withdrawal 151 • Pulmonary Balloon Valvuloplasty 151 – Indications 151 Chapter 14. Congenital Heart Disease 154 Sanjeev S Mukherjee • Device Closure 154 • Atrial septal Defect Closure 154 – Data to Support ASD Closure in Adults 154 – What to do, Device or Surgery? 155 – Definition of Rims 156 – TEE is performed in Three different planes 157 – Steps of Closure 157 – Procedure 157 – Tips 158 – Device selection tip 159 • Ventricular septal Defect Closure 159 – Indications for percutaneous closure of VSD (ACC/AHA, 2008 Guidelines) 159 Contents xxi – Criteria for percutaneous closure 160 – Contraindications for percutaneous closure 160 – Steps are 160 • Patent ductus arteriosus 161 – Indications for intervention in PDA (ESC guidelines, new version, 2010) 161 – Steps of Device Closure 161 Chapter 15. Complication of Percutaneous Coronary Intervention 164 Prithwiraj Bhattacharjee, Shuvanan Ray • Types of Complications 164 • Complications related to vascular access 164 • Management of complications 165 – Hematoma 165 – Pseudoaneurysm 165 – Retroperitoneal Bleed 166 – Femoral Artery Thrombosis 166 – Arteriovenous Fistula 167 – Neuralgic Complication 167 – Lower Limb Ischemia 167 – Protocol of Catheter-derived Thrombolysis 167 • Radial access complications 167 – Management 167 • Coronary complications 168 – Coronary perforation 168 – Management 169 – Coronary dissection 170 – Risk factors of Catheter-induced Coronary artery dissection 172 – Management 172 – Air embolism 174 – Coronary spasm 174 – No reflow phenomenon 174 – Retained or embolized hardwares 175 • Post-procedural complications 178 • Others 179 Index 183