Hello, everyone. My name is Abhirul Vij. I'm one of the interventional cardiologists from Cook County, Chicago. I will be talking about three topics in brief as part of our CVP curriculum educational series and this would be on percutaneous coronary interventions, guide catheters, and anticoagulation. So the first thing I'm going to talk about is percutaneous coronary intervention and our objectives are to identify what it means to do a percutaneous coronary intervention. How have we evolved over time on our techniques of PCI and what are the basics of PCI? How do you start? How do you get to the point of where you're doing the intervention? So the first part is how do you define it? So essentially as the term suggests, it's a percutaneous approach, so it's a non-surgical approach of coronary intervention where you are intervening in the coronary arteries and that intervention most of the times is a treatment intervention, meaning you're trying to reduce the stenosis in the coronary arteries and improve blood flow, but sometimes that can be diagnostic to identify the type of etiology of the occlusion and which is why it could sometimes be let's say intravascular ultrasound where it's more diagnostic modality and other times it could be interventional modality where it's balloon angioplasty, coronary stenting, atherectomy, or brachytherapy. So for evolution of PCI, again, our first coronary intervention was done by Dr. Gorencic in 1977, I believe, when we had done plain old balloon angioplasty to a left anterior descending artery, and this has evolved over time to various atherectomy tools which actually took, which were, which preceded our stenting era where we were doing rotational atherectomies, laser atherectomies, and our newest member on the block, which is now often common used as a shockwave, lithotripsy. Other modalities were brachytherapy, which were all ways to kind of reduce instant re-stenosis, or not instant re-stenosis, I'm sorry, re-stenosis of the coronary artery because there were no stents back then. And then in the late 90s, early 2000s, we went on with our bare metal stents, and then first generation drug eluting stents, and then the second generation drug eluting stents. Now there are a few pillars of a PCI. A PCI, let's say, if you, the ultimate goal is to stent the coronary, there are a few things you need before you can do that, and one of which is anticoagulation to reduce your risk of thrombosis while you're doing a procedure, so you don't want iatrogenic thromboembolic risks, then guiding catheters to get you to where you want to be, and a guide wire to work as a rail over which you can use your equipment, and then your ultimate intervention, which could be stent, balloon, atherectomy, or whatever modality you do decide on.

PCI

coronary artery blockages

stents

anticoagulation

blood flow