modern_pci_role_masterclass_for_doctors_FINAL.pptx

Moder pci role for doctors

1. Role of Modern PCI in Current Era Presented by DR. JAGHAT SHIWLANI Interventional Cardiologist SICVD Larkana

2. Why Modern PCI Matters Now • PCI has evolved from symptom relief to prognostic therapy • Shift from angiography-only guidance to intravascular imaging • Class I recommendation now in Left Main and complex lesions (ESC 2024)

3. Evolution of PCI — From Angio to Imaging Era • ESC 2024: IVUS is Class I for LMCA, complex calcified lesions • ACC/AHA 2023: Imaging-guided PCI reduces mortality and TLR • Syntax II, Ultimaster, and OPTION trials changed strategy

4. Guideline Shift — ESC/ACC 2024–25 • IVUS provides deep penetration and calcium arc assessment • Determines strategy BEFORE stent selection • Prevents underexpansion — #1 predictor of stent failure

5. Why Imaging is Mandatory (IVUS Evidence) • Calcified plaque is major cause of PCI failure • IVUS identifies depth, arc, and distribution of calcium • Modifies tool selection BEFORE stenting

6. Calcium — The Real Enemy of PCI • Rotablation: for concentric heavy calcium • IVL (Shockwave): for deep, 360° circumferential calcium • Wolverine: for focal fibrotic/plaque modification

7. Toolbox Evolution — Rota / IVL / Wolverine • FFR/iFR confirms ischemia before PCI • Reduces unnecessary stenting • Now standard before intermediate lesions

8. Physiology in Decision — FFR/iFR Logic • Stepwise workflow: 1. Angio roadmap 2. IVUS assessment 3. Calcium tool selection 4. Stent + post-IVUS optimization

9. Modern PCI Workflow Strategy • Case-based decision making • LMCA — IVUS mandatory • RCA calcified — Rota vs IVL based on arc morphology

10. Real-World Case Algorithm • Boston Scientific platforms lead in IVUS, IVL, and Rota synergy • Optimized system compatibility

11. Boston Scientific Innovation Edge • Complications predicted via IVUS: • Malapposition • Edge dissection • Plaque rupture risk

12. Complication Prediction & Prevention • Content will be expanded here • High-impact teaching flow • Cath-lab + evidence balance