Interventional Cardiology: High Risk/Complex PCI

  One of the great privileges of my particular specialty, Interventional Cardiology, is the ability to participate in the complete arc of patient care for Cardiovascular Disease. This begins with preventive strategies to include a heart healthy diet, regular exercise, sufficient sleep and positive lifestyle habits. It also includes treating associated risk conditions such as hypertension (high blood pressure), hyperlipidemia (high cholesterol), diabetes and sleep apnea. 

 Interventional Cardiology often involves emergency treatment of immediately life-threatening conditions. These commonly include acute myocardial infarction, also known as a “heart attack”, typically due to a blockage of one or more blood vessels supplying the heart muscle or cardiogenic shock, a complete collapse of the heart and lung system. Both conditions are usually treated with a coronary intervention or “stenting”, where permanent cardiac “stents” are inserted into the heart through small blood vessels of the wrist, sometimes with the aid of mechanical circulatory support devices, or small “heart pumps” inserted into the heart through the blood vessels of the leg. This is often how I meet my patients—in their most vulnerable hour. Fortunately, with current emergency interventional therapies, heart attack and cardiac collapse survival rates are at a historic high.

 Today, many patients also live with chronic coronary artery disease. Some of these patients are highly symptomatic, suffering frequent recurrent chest discomfort or difficulty breathing which limits day-to-day activities and adversely impacts their quality of life. Sometimes these symptoms may be managed effectively with diet, exercise, weight loss, and daily medications. For others, intervention with coronary stents may bring the most benefit. 

 Some forms of coronary artery disease that are inadequately treated with medications are so technically complex that patients may be inappropriately labelled as “no option” and stuck in limbo with a poor quality of life and no clear path forward to improvement. For me, this group, like emergency heart attack victims, is among the most gratifying to treat. 

 “No option” patients often actually have many options, which may include better medication therapy, as well as better procedural options. These procedures may include atherectomy, a debulking of heavy calcium deposits in coronary blood vessels, or chronic Coronary Total Occlusion (CTO) intervention, which involves stenting of longstanding complete heart blood vessel blockages. 

 Patients with very poor heart pumping function, also known as low ejection fraction, may also now be able to safely undergo procedures that were previously not possible with the aid of new mechanical circulatory support devices, or temporary miniature heart pumps inserted through the leg. These new techniques and technologies often facilitate the safe performance of “complex” and “high-risk” procedures previously not offered to patients. For some patients,  a referral to our cardiac surgical colleagues for Coronary Artery Bypass Grafting (“CABG” or “bypass surgery”) is the best path forward. 

 In the end, all of our patients deserve access to and consideration of the many contemporary therapeutic options currently available. At Virginia Heart, with over 45 specialists trained in every area of cardiology, we uniquely offer full-spectrum team-based cardiovascular care across the entirety of Northern Virginia. Most of all, we value collaborative decision-making with our patients and their families to create a happier healthier life for all.