Textbook of Interventional Cardiology

INTERVENTIONAL CARDIOLOGY
Copyright
Dedication
Contributors
Preface
1 - Individualized Assessment for Percutaneous or Surgical-Based Revascularization
	Need for Individualized Patient Assessment
		Patient Comorbidities
	Technologic Advances
	Historic (Pre-Syntax) Clinical Trial Results
		SYNTAX Trial
	Individual Assessment from A Physician’s Perspective
		Qualitative Versus Quantitative Risk Assessment
		Risk Scores in Contemporary Practice
			Clinical Scores
				EuroSCORE and EuroSCORE II
				New Mayo Clinic Risk Score
				Value of Age, Creatinine, and Ejection Fraction Score
				National Cardiovascular Database Registry CathPCI Risk-Prediction Score
			Angiography-Based Scores
				American College of Cardiology/American Heart Association Lesion Classification System
				Anatomic SYNTAX Score
				Myocardial Jeopardy Scores
			Combined Risk Scores
				Society of Thoracic Surgery Score
				EuroHeart Score
				New Risk Stratification Score
				SYNTAX-Based Tools
	SYNTAX-Based Clinical Tools
		Anatomic SYNTAX Score
		Functional SYNTAX Score
		Augmenting the Anatomic SYNTAX Score With Clinical Factors and the Personalization of Decision Making: Development of SYNTAX Sco...
			Age, Serum Creatinine, and Ejection Fraction
			Clinical SYNTAX Score/Logistic Clinical SYNTAX Score
			Global Risk
		SYNTAX Score II
			Diabetics
			Impaired Left Ventricular Ejection Fraction
			Validation of SYNTAX Score II
			EXCEL Trial
			SYNTAX II Trial
		Tools for Assessment of Completeness of Revascularization
			Residual SYNTAX Score
			Post–Coronary Artery Bypass Grafting SYNTAX Score
		Future Directions
		SYNTAX III Revolution Trial Noninvasive Heart Team Assessment of Multivessel Coronary Disease With Coronary Computed Tomography ...
	Individual Assessment from a Patient’s Perspective
	Conclusions
2 - Evidence-Based Interventional Practice
	Overview
		Changing Paradigms of Coronary Revascularization
		The Scope of This Chapter
	Prognostic Indications for Myocardial Revascularization
		Clinical Presentation
			Myocardial Infarction and High-Risk Unstable Angina
		Coronary Anatomy
		Need for Complete Revascularization
		Multivessel Disease
			Registries
				Randomized Studies
			Special Considerations in Patients With Diabetes Mellitus
			Studies With Bare-Metal Stents
			Studies With Drug-Eluting Stents
		Left Main Coronary Artery Disease
			Registries with Drug-Eluting Stents
				Randomized Studies With Drug-Eluting Stents
	Percutaneous Coronary Intervention Versus Medical Therapy Alone
3 - Diabetes
	Pathophysiology of Atherosclerosis in Diabetes
	Cardiovascular Disease in Diabetes
	Myocardial Ischemia Detection in Diabetic Patients
		Revascularization in Diabetic Patients With Stable Coronary Artery Disease
		Percutaneous Coronary Intervention
		Coronary Artery Bypass Surgery
	Revascularization Versus Medical Management
		Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Stable Diabetic Patients With Multivessel Disease
	Diabetes and Non–ST-Elevation Acute Coronary Syndromes
	Early Invasive Versus Conservative Strategy
	Diabetes and ST-Elevation Myocardial Infarction
		Choice of Revascularization Modality in Patients With Acute Coronary Syndromes
	Glucose-Lowering Therapy in the Acute Phase of Acute Coronary Syndromes
		Long-Term Antidiabetic Therapy
		Antithrombotic Therapy in Diabetes
	Aspirin and Clopidogrel
	Prasugrel and Ticagrelor
	Glycoprotein IIb/IIIa Receptor Antagonists and Anticoagulants
	Long-Term Diabetes Management
	Multifactorial Intervention
4 - Noninvasive Evaluation: Functional Testing, Multidetector Computed Tomography, and Stress Cardiac MRI
	Stress Testing
		Exercise Stress Testing
		Electrocardiography Stress Testing
		Stress Echocardiography
			Exercise Echocardiography
			Pharmacologic Stress Echocardiography
	Contrast Perfusion Imaging
		Stress Scintigraphic Myocardial Perfusion Imaging
		Exercise Scintigraphic Myocardial Perfusion Imaging
		Pharmacologic Scintigraphic Myocardial Perfusion Imaging
	Cardiac Magnetic Resonance Imaging
		Cardiac Magnetic Resonance Vasodilator Perfusion Imaging
		Dobutamine and Exercise Stress Cardiac Magnetic Resonance
	Myocardial Viability Assessment
		Cardiac Computed Tomography
		Coronary Artery Calcium Scoring
		Contrast-Enhanced Computed Tomography Coronary Angiography
		Stress Myocardial Computed Tomography Perfusion Imaging
		Coronary Fractional Flow Reserve Computed Tomography
		Coronary Computed Tomography Angiography in Acute Chest Pain
	Hybrid Imaging
	Appropriate Use Criteria
	Radiation Exposure Relative Health Risks
	Conclusions
5 - Intracoronary Pressure and Flow Measurements
	Fundamental Concepts of Coronary Blood Flow
		Coronary Flow and Flow Reserve
		Intracoronary Pressure Measurements and Fractional Flow Reserve
	Methodology of Coronary Pressure Measurement
		General Setup and Guidewire Manipulation
		Safety of Intracoronary Sensor Wire Measurements
		Pharmacologic Hyperemic Stimuli
			Adenosine
			Regadenoson
			Dobutamine
			Sodium Nitroprusside
		Clinical Validation of Intracoronary Pressure Measurements
		Fractional Flow Reserve and Myocardial Perfusion Imaging
		Fractional Flow Reserve and Angiography
		Decision Making in the Fractional Flow Reserve “Gray Zone”
		Intracoronary Physiologic Measurements, Intravascular Ultrasound, and Optical Coherence Tomography Measurements
		Deferring Percutaneous Coronary Intervention for Lesions With Nonsignificant Fractional Flow Reserve
		Percutaneous Coronary Intervention Versus Medical Therapy for Significant Fractional Flow Reserve
		Fractional Flow Reserve in Daily Clinical Practice
		Implications for Fractional Flow Reserve in Patients With Multivessel Coronary Artery Disease and Coronary Artery Bypass Graftin...
		Cost Effectiveness of a Routine Fractional Flow Reserve–Based Strategy
		Left Main Coronary Artery Disease
		Complex Left Main Coronary Artery Lesion Assessment (Left Main Coronary Artery Plus Downstream Lesions) With Fractional Flow Res...
		Serial (Multiple) Lesions in a Single Vessel
		Diffuse Coronary Disease
		Ostial Lesions and Jailed Side Branches
		Fractional Flow Reserve in Acute Coronary Syndromes
		Fractional Flow Reserve in ST Elevation Myocardial Infarction Patients
		Post–Percutaneous Coronary Intervention Fractional Flow Reserve
		Fractional Flow Reserve and Transcatheter Aortic Valve Implantation for Aortic Stenosis
		Simultaneous Measurement of Flow Velocity and Transstenotic Pressure Gradient
		Nonhyperemic Pressure Ratio Indices of Coronary Stenosis Significance
		Nonhyperemic Pressure Ratios
		Instantaneous Wave-free Pressure Ratio and Clinical Outcome
	Conclusion
6 - Contrast-Induced Acute Kidney Injury and the Role of Chronic Kidney Disease in Percutaneous Coronary Intervention
	Introduction
	Definition of Contrast-Induced Acute Kidney Injury
	Pathophysiology
	Epidemiology and Risk Factors for Contrast-Induced Acute Kidney Injury
	Predicting the Risk of Contrast-Induced Acute Kidney Injury
		Risk Scores
		Biomarkers for Risk Prediction and Early Detection of Contrast-Induced Acute Kidney Injury
	Prognosis of Contrast-Induced Acute Kidney Injury
	Chronic Kidney Disease
		Epidemiology and Definition
		Chronic Kidney Disease in Patients Undergoing Percutaneous Coronary Intervention
	Prevention Strategies to Minimize the Risk of Contrast-Induced Acute Kidney Injury
		Periprocedural Hydration
		N-Acetyl Cysteine and Sodium Bicarbonate
		Statins
	Transcatheter Aortic Valve Replacement Population
	Critical View and Future Demands
7 - Radiation Safety During Cardiovascular Procedures
	INTRODUCTION
	RADIATION RISK
	RADIATION MANAGEMENT
	FLUOROSCOPIC IMAGING EQUIPMENT
		Image Chain Components
		Imaging Modes
	PATIENT RADIATION DOSE MANAGEMENT
		Factors That Contribute to High Skin Dose
		Radiation Dose Measurement
		Best Practices for Patient Dose Management
	STAFF RADIATION PROTECTION
		Occupational Dose Monitoring
		Sources of Personnel Radiation Exposure
		Personal Protective Equipment
8 - Coronary and Valvular Intervention Prior to Noncardiac Surgery
	INTRODUCTION
	Perioperative Myocardial Infarction
	Indications for Preoperative Coronary Angiography
	Pharmacologic Therapy for Noncardiac Surgery
	Preoperative Percutaneous Coronary Intervention
		Stable Coronary Artery Disease
		Unstable Coronary Artery Disease
		Revascularization Technique
			Balloon Angioplasty
			Stent Placement
		Coronary Artery Bypass Grafting
	Unanticipated Surgery After Stenting
		Antiplatelet Drug Interruption
		Antiplatelet Therapy and Surgical Bleeding Risk
	Summary and Recommendations
	Investigational Strategies
		Perioperative Bridging
		Platelet Function Testing
	Novel Drug-Eluting Stent Platforms
		Postoperative Care
		Aortic Stenosis and Noncardiac surgery
9 - Sex and Ethnicity Issues in Interventional Cardiology
	Overview
	Sex
		Characteristics and Outcomes of Women Undergoing Percutaneous Coronary Intervention
		Sex and Percutaneous Coronary Devices and Adjuvant Therapies
	Vascular Complications
		Sex Differences in Lesion Subsets
		Sex Differences in Acute Coronary Syndrome
			Non–ST-Elevation Acute Coronary Syndromes
			ST-Elevation Myocardial Infarction
	Sex Differences in Adjunctive Pharmacotherapy
		Antiplatelet Therapy
			Aspirin
			P2Y12 Inhibitors
			Glycoprotein IIb/IIIa Inhibitors
		Antithrombin Agents
			Unfractionated Heparin
			Low-Molecular-Weight Heparin
			Direct Thrombin Inhibitors
		Other Adjuvant Pharmacotherapy and Post–Acute Coronary Syndrome Treatments
		Sex-Specific Causes of Acute Coronary Syndromes
			Stress Cardiomyopathy
			Spontaneous Coronary Artery Dissection
			Microvascular Angina
	Sex Differences in Structural Interventional Procedures
	Sex Differences in Peripheral Interventional Procedures
	Race and Ethnicity
		Disparities in Coronary Artery Disease
		Characteristics of Racial and Ethnic Minorities Undergoing Intervention
		Acute Coronary Syndrome
		Social Aspects of Health Care Disparities
	Conclusion
10 - Platelet Inhibitor Agents
	Basic principles of antiplatelet therapy
	ASPIRIN
		Mechanism of Action
		Pharmacokinetics and Pharmacodynamics
			Aspirin Dose After Percutaneous Coronary Intervention
	P2Y12 Inhibitors
		Basic Principles
		Thienopyridines
			Ticlopidine
				Pharmacodynamics
					ST-Elevation Myocardial Infarction. The Clopidogrel as Adjunctive Reperfusion Therapy–Thrombolysis in Myocardial Infarction (CLA...
				Pretreatment for Percutaneous Coronary Intervention
				Dosing Strategies
				The Role of CYP2C19
				Predicted Metabolic Phenotype
				CYP2C19 and Clinical Outcomes
				U.S. Food and Drug Administration’s Boxed Warning
					ABCB1. P-glycoprotein is an adenosine triphosphate (ATP)–dependent efflux pump encoded by the ABCB1 gene. It is expressed in the...
			Proton Pump Inhibitors
		Prasugrel
			Metabolism
			Pharmacodynamics
			Clinical Studies
		Nonthienopyridines
			Ticagrelor
				Pharmacology and Metabolism
				Pharmacodynamics
				Clinical Studies
				Adverse Effects
					Clinical Studies. Three randomized clinical trials have assessed the safety and efficacy of cangrelor during urgent and nonurgen...
					Adverse Effects. Pooled analysis of patient-level data from the CHAMPION trials demonstrated that cangrelor bolus and infusion d...
		Thrombin Receptor Antagonists
			Basic Principles
			Vorapaxar
		Phosphodiesterase Inhibitors
			Cilostazol
		Glycoprotein IIb/IIIa Inhibitors
			Pharmacology
				Abciximab
				Epitifibatide
				Tirofiban
				Thrombocytopenia
			Pivotal Clinical Trials With Glycoprotein IIb/IIIa Inhibitors
			Timing of Glycoprotein IIb/IIIa Administration
				Duration of Oral Dual-Antiplatelet Therapy
			Prediction Scores
		Triple-Antithrombotic Therapy: Considerations for the Patient With Atrial Fibrillation Undergoing Percutaneous Coronary Infarcti...
		Platelet Function Testing
			GRAVITAS
			ARCTIC
			Other Studies
			Switching Antiplatelet Therapy
	Conclusion
11 - Anticoagulation in Percutaneous Coronary Intervention
	INTRODUCTION
	The Biology of Atherothrombosis
		The Central Role of Thrombin
	Adverse Events Following Percutaneous Coronary Intervention
		Unfractionated Heparin
		Enoxaparin
		Fondaparinux
		Direct Thrombin Inhibitors
	New Pharmacologic Targets
	Anticoagulant Therapy in STEMI, NSTEACS, and Elective Percutaneous Coronary Intervention
		ST-Elevation Myocardial Infarction
		Non–ST-Elevation Acute Coronary Syndrome
		Percutaneous Coronary Intervention for Stable Coronary Artery Disease
	Special Patient Groups
		Patients Transitioning From “Upstream” Management to the Catheterization Lab
		Patients With Renal Impairment
		Diabetic Patients
		Patients With Heparin-Induced Thrombocytopenia
	Conclusion
12 - Thrombolytic Intervention
	Thrombolytic Agents
	Major Historical Comparative Thrombolytic Trials
	Timing of Thrombolytic Therapy
		Early Treatment
		Late Treatment
	Adjunctive Therapies
		Aspirin
		P2Y12 Receptor Antagonists
		Heparin
		Direct Thrombin Inhibitors
		Glycoprotein IIb/IIIa Inhibitors
		Factor Xa Inhibitors
	Facilitated Percutaneous Coronary Intervention
	Pharmacoinvasive Strategy
	International Perspective
13 - Other Adjunctive Drugs for Coronary Intervention: Beta-Blockers, Calcium-Channel Blockers, and Angiotensin-Converting Enzyme Inhibitors
	β-Adrenergic Receptors
		β-Adrenergic Receptor Blockers
		Unstable Angina Pectoris
		Percutaneous Coronary Intervention
		Acute Myocardial Infarction
			Early Trials: The MIAMI and ISIS-1 Trials
				The MIAMI Trial
				The ISIS-1 Trial
			COMMIT and Other Trials
				Patient Selection
				Study Protocol
				End Points
				Results
				Meta-Analysis Using COMMIT Patients
				Chronic Therapy After Myocardial Infarction
				Patient Selection: Role of Genomics
	Calcium Channels
		Calcium-Channel Blockers
		Acute Myocardial Infarction
		Recommendations for Acute Coronary Syndromes
		Chronic Therapy After Myocardial Infarction
			Early Trials
			More Recent Trials
				The CAMELOT Trial
				The INVEST Trial
		Percutaneous Coronary Intervention
		Angiotensin-Converting Enzyme
		Angiotensin-Converting Enzyme Inhibitors
		Percutaneous Coronary Intervention
		Acute Myocardial Infarction
	Conclusion
14 - Coronary Stenting: Practical Considerations, Equipment Selection, Tips and Caveats
	Introduction
	Access Site Selection
		Radial Access
		Femoral Access
	Guide Catheter Selection
	Guide Extensions
	Coronary Guidewire Selection
		Workhorse and Specialty Crossing Wires
		Extra Support Wires
	Coronary Microcatheters and Over the Wire Balloons
	Stent Selection
	Facilitated Stent Delivery
	Coronary Atherectomy
	Contrast and Radiation Sparing
	Management of Complications
	Conclusion
15 - Coronary Stenting
	introduction
	Bare-Metal Stent Overview
		Limitations of balloon angioplasty and development of the coronary stent
		Stent Design: Impact on Performance and Clinical Outcomes
			Classification
				Stent Composition
				Stent Configuration and Design
				Stent Coatings
				Balloon-Expandable Versus Self-Expanding Stents
			Routine Stenting During Percutaneous Coronary Intervention
	Drug-Eluting Stents Overview
		Limitations of Bare-Metal Stents
		Components of Drug-Eluting Stents
			Drug-Eluting Stents Stent Designs
			Basic Drug-Eluting Stents Pharmacology
			Drug-Eluting Stents Polymers and Drug Carrier Systems
		Generational Classification of Drug-Eluting Stents
			First-Generation Drug-Eluting Stents
				The Cypher Sirolimus-Eluting Stent
				The Taxus Paclitaxel-Eluting Stent
				Comparisons of First Generation DES
				Limitations of First-Generation Drug-Eluting Stents
			Second-Generation Drug-Eluting Stents
				Durable Polymer-Based Second-Generation Drug-Eluting Stents
				Cobalt-Chromium Everolimus-Eluting Stents (Xience)
				Cobalt-Chromium Everolimus-Eluting Stents Versus First-Generation Drug-Eluting Stents
				Cobalt-Chromium Everolimus-Eluting Stents Versus Bare-Metal Stents
				Cobalt-Chromium Everolimus-Eluting Stents Versus Second-Generation Drug-Eluting Stents
				Platinum-Chromium Everolimus-Eluting Stents (Promus Element/Premier)
				Zotarolimus-Eluting Stent (Endeavor)
				Re-ZES (Resolute)
			BP-BES (Biomatrix/NOBORI) and Comparisons with First-Generation Drug-Eluting Stents
			BP-BES (Biomatrix/NOBORI) and Comparisons with Second-Generation Drug-Eluting Stents
			Novel BP-BASED Drug-Eluting Stents: Orsiro and Synergy
				Other BP-Based Drug-Eluting Stents
	Polymer-Free Drug-Eluting Stents
		Conclusions
	Stents in Specific Situations
		Acute ST-Segment Elevation Myocardial Infarction
			Stents to Reduce Distal Embolization in STEMI
		Diabetes Mellitus
		Left Main and Multivessel Disease
		Chronic Total Occlusions
		Bifurcation Lesions
		Saphenous Vein Grafts
	Stent Failure Mechanisms and Management
		Stent Thrombosis
			Dual Antiplatelet Therapy and Stent Thrombosis
		Restenosis
			Treatment of Restenosis
	Conclusions and Future Directions
16 - Bioresorbable Coronary Scaffolds
	Introduction
	Rationale and Promises of Bioresorbable Scaffold
	Historic Development
	Materials and Properties
		Polymers
			Poly(Aliphatic-Esters)
			Non-Poly(Aliphatic-Esters)
		Corrodible Metals
			Magnesium Alloys
			Iron Alloys
	Current Landscape of Clinically Tested Bioresorbable Scaffold
		Igaki-Tamai
		Absorb
		DESolve
		Reva Medical Bioresorbable Scaffolds
		Art Pure
		Amaranth Bioresorbable Scaffolds
		Ideal BioStent
		MeRes
		Mirage
		Firesorb
		Xinsorb
		Magmaris
		NeoVas
	From Initial Trials and Promises to Current Status and Future Outlook
17 - Drug-Eluting Balloons
	Preclinical Data
	Clinical Data on Drug-Coated Balloons
		Human Pharmacokinetics of Current Drug-Coated-Balloon Technology
		Data From the Coronary Application of Drug-Coated Balloons
			Coronary In-Stent Restenosis
			Coronary De Novo Disease
		Clinical Data From the Peripheral Vascular Application of Drug-Coated Balloons
	The Future of Drug-Coated-Balloon Technology
18 -
Elective Intervention for Stable Angina or Silent Ischemia
	INTRODUCTION
	REVASCULARIZATION IN PATIENTS WITH CHRONIC STABLE ANGINA
	Percutaneous Coronary Revascularization: Efficacy on Symptom Improvement
	Percutaneous Coronary Revascularization: Effect on Clinical End Points
	SELECTION OF REVASCULARIZATION STRATEGY
	Tools for Selection of Therapy
	Silent Myocardial Ischemia
	SUMMARY
	REFERENCES
19 - Intervention for Non–ST-Segment Elevation Acute Coronary Syndromes
	Overview
	Risk Stratification
		Ischemic Risk Stratification
		Bleeding Risk Stratification
	Approach to Revascularization
		Immediate Angiography
		Invasive Versus Ischemia-Guided Strategy
		Timing of the Intervention: Early Versus Delayed Invasive Strategy
	Adjunctive Antithrombotic Therapies in NSTE-ACS
		Antiplatelet Therapy
			Aspirin
			Clopidogrel
			Prasugrel
			Ticagrelor
			Cangrelor
		Parenteral Anticoagulant Therapy
			Unfractionated Heparin
			Low Molecular Weight Heparin
			Fondaparinux
			Bivalirudin
		Glycoprotein IIb/IIIa Receptor Inhibitors
			Abciximab
			Tirofiban
			Eptifibatide
	Radial VERSUS Femoral Approach
	Considerations in Patients with Nste-Acs and Complex Coronary Disease
		Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft
			Multivessel Disease
			Left Main Coronary Artery Disease
				Patients with Left Ventricular Dysfunction
	Culprit-Vessel Versus Multivessel Percutaneous Coronary Intervention
	Single-Sitting Versus Staged Multivessel Percutaneous Coronary Intervention
20 - Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction
	Introduction
	General Aspects
		Primary Percutaneous Coronary Intervention Versus Fibrinolysis as Reperfusion Strategy for ST-Elevation Myocardial Infarction
	Time-To-Reperfusion and Outcome of Primary Percutaneous Coronary Intervention
	Primary Percutaneous Coronary Intervention in Late Presenters
	Interhospital Transfer for Primary Percutaneous Coronary Intervention
	Facilitated Percutaneous Coronary Intervention
	Rescue Percutaneous Coronary Intervention
	Primary Stenting
		Drug-Eluting Stents
		Drug-Eluting Balloons
		Bioresorbable Vascular Scaffolds
		Mesh-Covered Stents
		Self-Expanding Stents
		Direct Stenting
	Multivessel Intervention in Patients with St-Segment Elevation Myocardial Infarction
	Distal Protection Devices in Primary Percutaneous Coronary Intervention
	Mechanical and Aspiration Thrombectomy
	Deferred Stenting
	Antithrombotic Therapy in Patients with St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention...
	Anticoagulant Therapy in Patients with St-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
	Glycoprotein IIB/IIIA Inhibitors
	Cell-Based Therapy and Regenerative Agents After St-Elevation Myocardial Infarction
	Special Issues in Primary Percutaneous Coronary Intervention
		Out-of-Hospital Cardiac Arrest
		Cardiogenic Shock
		Primary Percutaneous Coronary Intervention During Presentation Off-Hours
		Primary Percutaneous Coronary Intervention in Elderly
		Primary Percutaneous Coronary Intervention in Women
		Primary Percutaneous Coronary Intervention in Hospitals with and Without Onsite Coronary Artery Bypass Graft Surgery
	Conclusion
21 - Post-Percutaneous Coronary Intervention Hospitalization, Length of Stay, and Discharge Planning
	Introduction
	Post-Percutaneous Coronary Intervention Discharge Planning
		Physician-to-Patient Communication
		Access Site Management
		Postprocedure Ambulation
		Postprocedure Monitoring
		Discharge Physical Examination
		Discharge Instructions
		Medication Reconciliation
		Communication to Referring Physician
		Follow-Up
	The Role of Post-Percutaneous Coronary Intervention Monitoring of Cardiac Biomarkers, Platelet Inhibition, and Renal Function
		Platelet Function
		Renal Function
	Trends in PostProcedure Length of Stay
		Technological, Pharmacological, and Procedural Advances
		Payer Expectations
	Same-Day Discharge Following Percutaneous Coronary Intervention
		History and Background
		Safety of Same-Day Discharge
		Patient Selection
		Selected Patient Populations
			Acute Coronary Syndrome
			Transfemoral Access
			Elderly
		Patient Satisfaction With Same-Day Discharge
		Economic Impact of Same-Day Discharge
		Recommendations for Safe Same-Day Discharge
			Preprocedure Screening
			Procedural Characteristics
			Postprocedural Monitoring
			After Discharge
	Conclusions
22 - Interventions in Cardiogenic Shock
	Background
	Pathophysiology
	Clinical Presentation
		The SHOCK Trial and the SHOCK Registry
		Etiology
		Clinical Manifestations
	Treatment
		Role of Right Heart Catheterization
		Inotropes
			Mechanical Support
		Reperfusion in Cardiogenic Shock
			Percutaneous Coronary Intervention in Cardiogenic Shock
	Multivessel Disease
	Long-Term Survival and Quality of Life
	Conclusion
23 - Bifurcations and Branch Vessel Stenting
	Bifurcation Lesions
		Contemporary Studies
		Approach to Treatment of Bifurcation Lesions
		Guiding Catheter Selection
		A General Outline When Treating a Bifurcation Lesion
		Difficult Side Branch Access
		The Role of Final Kissing Balloon Inflation
		A Second Stent in the Side Branch Following Provisional Approach
		The European Bifurcation Club Approach to Bifurcation Stenting
	Two Stents as Intention-to-Treat
	Two-Stent Techniques
		The Culotte Technique
			Technique Description
		The Mini-Crush Technique (Side-Branch Stent Crushed by the Main Branch Stent)
			Technique Description
		Step Crush and Double-Kissing Crush
			Technique Description
		The V and the Simultaneous Kissing Stent Techniques
			Technique Description
		The “Y” and the “Skirt” Techniques
		Flower Petal Stenting
		Left Main Bifurcation Stenting
		Controversies in the Technical Approach to Isolated Ostial Left Anterior Descending or Circumflex Lesions
		Dedicated Bifurcation Stents
		BioResorbable Scaffolds
	Role of Adjunctive Procedures
		Intracoronary Imaging
		Rotational Atherectomy
		Cutting and Scoring Balloons
		Associated Pharmacological Treatment
	Conclusions
24 - Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Stenosis
	introduction
	Anatomy and Pathology
		Definition of Significant Left Main Coronary Artery Stenosis
	Stenting Techniques
		Ostial and Shaft Lesion
		Bifurcation Lesion
			Provisional One-Stent Strategy
			Elective Two-Stent Strategy
		Intravascular Ultrasound Guided Left Main Stenting
		Hemodynamic Support and Cardiogenic Shock
		Medical Treatment Versus Revascularization
	Stent Thrombosis and Antiplatelet Therapy after Drug-Eluting Stent Implantation
		In-Stent Restenosis After Left Main Coronary Artery Drug-Eluting Stenting
		Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Left Main Coronary Artery Stenosis
			Registry Data
			Randomized Trials
			Meta-analysis
	Current Status of Left Main Coronary Artery Percutaneous Coronary Intervention and Selection of Revascularization Strategy
	Conclusions
25 - Complex and Multivessel Percutaneous Coronary Intervention
	Introduction
	Multivessel Disease: Prevalence and Prognostic Implications
		The SYNTAX Trial
		The BEST Trial
		The FREEDOM Trial
		Clinical Outcomes From Meta-Analyses and Large Registries
		Meaningful Message for Clinical Practice
		Fractional Flow Reserve and the FAME Trial
		Refining the SYNTAX Score
			SYNTAX II Score
			Residual and Coronary Artery Bypass Grafting SYNTAX Score
			Functional SYNTAX Score
		Intravascular Imaging to Guide and Optimize Percutaneous Coronary Intervention Procedures
		Secondary Prevention: An Important Clinical Goal After Revascularization
		Combining Different Strategies to Improve Percutaneous Coronary Intervention Outcomes of Multivessel Disease: The SYNTAX II Stud...
		Meaningful Message for Clinical Practice
	Managing Multivessel Disease in Patients with Stemi
	Conclusions
26 - Intervention for Coronary Chronic Total Occlusions
	Chronic Total Coronary Occlusion
	Definition
	Prevalence
	pathology
	Clinical Profile and Presentation
	Indications for Revascularization
	Ischemia and Left Ventricle Function
	Collateral Circulation
	Preparation for Chronic Total Occlusion Percutaneous Coronary Intervention
		Scoring Systems to Stratify Difficulty of Chronic Total Occlusion Percutaneous Coronary Intervention
	Approaches and Techniques
		Antegrade Approach
			Antegrade Wire Escalation
			Antegrade Dissection/Reentry
			Retrograde Approach
			Retrograde Wire Escalation
			Retrograde Dissection and Reentry Techniques
		Hybrid Algorithm
		Asia-Pacific Algorithm
	Clinical Outcomes
		Observational Data
		Randomized Controlled Trials
	Conclusion
27 - Bypass Graft Intervention
	The Scope of the Problem
	Indications for Intervention
		Early Postoperative Period
		One to Three Years After Surgery
		More Than Three Years After Surgery
		Acute ST-Segment Elevation Myocardial Infarction
	Technical Strategy
	Results of Intervention
		Percutaneous Coronary Intervention Versus Reoperation
		Vein Graft Intervention
		Bare-Metal Stents Versus Balloon Angioplasty in Vein Grafts
		Drug-Eluting Stents in Vein Grafts
		Embolic Protection
		Adjunctive Pharmacotherapy
		Restenosis Lesions in Saphenous Vein Grafts
			Total Occlusion of Saphenous Vein Grafts
		Internal Mammary Artery Grafts
	Complications
		Perforation
		No-Reflow Phenomenon
	The Future of Bypass Graft Intervention
28 - The Thrombus-Containing Lesion
	Introduction
	Processes of Thrombus Formation: Histopathology and Types
	Thrombus Architecture and Related Characteristics
	Detection of Thrombus-Containing Lesions
	The Grading and Classification of Thrombi
	Targeted Thrombus Revascularization Strategies
	Pharmacotherapy
	Mechanical Thrombus Removal
		Adjunctive Thrombectomy
		Embolic Protection
		Power-Sourced Thrombectomy
		Combined Pharmacothrombectomy
	Stents for Targeted Thrombus Capture
	Specific Thrombotic Lesions: Location, Effects, and Management Options
		The Hostile Clot
		Stent Thrombosis
	Left Main Coronary Lesions
	Multivessel Coronary Thrombosis
	Multiple Thrombi in a Single Vessel
	Chronic Thrombotic Occlusion
	Saphenous Vein Graft
29 - Complications of Percutaneous Coronary Intervention
	Introduction
	Abrupt Closure
		Incidence
		Mechanisms
		Prognostic Significance
		Treatment
		Unsuccessful Outcome
		Stent Thrombosis
	Coronary Perforation
		Incidence
		Mechanism
		Prognosis
		Diagnosis
		Management
		Iatrogenic Ascending Aortic Dissection
	Embolization of Percutaneous Coronary Intervention Equipment
		Incidence
		Prognosis
		Treatment
	Emergency Coronary Bypass Surgery
		Incidence
		Prognosis
		Myocardial Infarction
			Incidence
			Mechanism
			Prognosis
			Prevention—Pharmacotherapy
	Coronary No-Reflow
		Incidence and Diagnosis
		Prevention
		Treatment
		Prognosis
		Air Embolism
			Incidence
			Diagnosis
			Treatment
	Radiocontrast Hypersensitivity
		Incidence and Prognosis
		Prevention and Treatment
	Bleeding
	Conclusion
30 - Periprocedural Myocardial Infarction and Embolism-Protection Devices
	Periprocedural Myocardial Infarction
	Embolism Protection Devices
	Definition
		The Third Universal Definition of Myocardial Infarction: Definition of Periprocedural Myocardial Infarction
		The Society of Cardiac Angiography and Interventions Expert Consensus Proposed Definition of Periprocedural Myocardial Infarctio...
		Enzyme Elevation and Imaging Evidence of Myonecrosis
	Incidence
	Underlying Pathophysiologic Mechanisms
		Distal Embolization and Periprocedural Myocardial Infarction
		Platelet Activation
		Periprocedural ST-Segment–Elevation Myocardial Infarction
	RISK FACTORS PREDISPOSING TO PERIPROCEDURAL MYOCARDIAL INFARCTION
		Clinical Characteristics
		Lesion-Related Risk Factors
		Procedural Complications and Risk of Periprocedural Myocardial Infarction
		Risk of Periprocedural Myocardial Infarction by Interventional Device
	Prognostic Implications of Periprocedural Myocardial Infarction
	Prevention and Management of Periprocedural Myocardial Infarction
		Intravenous Glycoprotein IIb/IIIa Platelet Inhibitors
		Direct Thrombin Inhibitors (Bivalirudin)
		P2Y12 Platelet Inhibitors
		Impact of Statin Therapy
		Nonpharmacologic Approaches
	Conclusions
	Embolic Protection Devices
		Distal Filter Devices
		Distal Occlusion Devices
		Proximal Occlusion Devices
	Saphenous Vein Graft Percutaneous Coronary Intervention
		Percutaneous Coronary Intervention for Acute Myocardial Infarction
		High-Risk Native Plaques
		Carotid Stenting
		Distal Embolism Protection Devices in Carotid Stenting
		Proximal Embolism Protection Devices in Carotid Stenting
		Cerebral Embolic Protection Device Use During Transcatheter Aortic Valve Replacement
	Conclusions
31 - Access Management and Closure Devices
	Introduction
	Planning Access
	Retrograde Puncture Technique for the Femoral Artery
		Patient Preparation
		Anatomical Considerations
		Choice of Puncture Site
			Traditional Palpatory Method
			Fluoroscopic Visualization Method
			Ultrasound-Guided Femoral Access
			Micropuncture
	Antegrade Puncture Technique for the Femoral Artery
	Puncture Technique for the Brachial Artery
	Puncture Technique for the Popliteal Artery
	Transapical Left Ventricular Puncture
	Hemostatic Methods After Percutaneous Cardiovascular Procedures
		Manual and Mechanical Compression
		Femoral Closure Devices
			Passive Devices
			Active Devices
				Plug-Based Sealing Devices
				Suture-Based Closure Devices
				Electrical-Based Sealing Pads
	Access-Site Complications
		Hematoma
		Retroperitoneal Hemorrhage
			Pseudoaneurysm
			Arteriovenous Fistula
			Vessel Occlusion
			Access-Site Infections
	Conclusions and Future Trends
32 - Transradial Access for Cardiovascular Catheterization and Intervention
	introduction
	Rationale for Transradial Approach to Percutaneous Coronary Intervention
		Anatomic Considerations
	Feasibility and Security
	Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention
	Transradial Approach in St-Elevation Myocardial Infarction
	Transradial Versus Transbrachial Approaches
	Transradial Versus Transulnar Approach
	Cost-Effectiveness
	Practical Considerations for a Transradial Approach
		Contraindications to the Transradial Approach
		Assessment of Ulnopalmar Arterial Arches
			The Allen Test
				Right Versus Left Transradial Approach
		Patient Preparation, Arterial Puncture, and Sheath Insertion
		Prevention of Radial Artery Spasm
		Anticoagulation
		Glycoprotein IIb/IIIa Inhibitors and Fibrinolytics
		Guiding Catheters
		Difficult Anatomy
		Repeat Transradial Procedures
		Complications
		Conclusions
33 - Role of the Cardiac Surgeon and the Heart Team
	Introduction
	Role of The Surgeon on Surgical Standby
	Transcatheter and Hybrid Cardiovascular Procedures
	Transcatheter Aortic Valve Replacement
		Percutaneous Mitral Valve Repair
		Transcatheter Mitral Valve Replacement
		Endovascular Aortic Repair
		Hybrid Coronary Revascularization
	Hybrid Cardiac Surgeon
		Hybrid Suite
		Cardiac Surgeon in Innovation
		Training for Future Hybrid Cardiac Surgeon/Interventionalist
34 - Restenosis
	Introduction
	Arterial Injury and Mechanisms of Restenosis
		Normal Versus Pathologic Response to Arterial Injury
		Endothelial Cell and Platelet Activation
		Inflammation
		Smooth Muscle Cell Proliferation
		Cell Cycle Regulation and the Rationale for Drug-Eluting Stent Development
		Sirolimus and Its Analogues
		Paclitaxel
	Angiographic and Clinical Features of Restenosis
		Definitions–Angiographic Restenosis
		Clinical Restenosis
		Incidence of Restenosis
		Patterns of Restenosis
		Predictors of Restenosis
	Prevention of Restenosis–Drug-Eluting Stent Evolution and Redesigns
		Scaffold Design
		Drug Elution
		Polymer and Elution Kinetics
		Clinical Outcomes With Newer Generation Drug-Eluting Stent
	Treatment of Restenosis
		After Percutaneous Transluminal Coronary Angioplasty
		After Bare-Metal Stents
		After Drug-Eluting Stents
		Role of Intravascular Imaging
		Debulking and Other Plaque Modifying Modalities
35 - Role of Adjunct Devices: Atherectomy, Cutting Balloon, and Laser
	Historical Background
	Percutaneous Transluminal Rotational Atherectomy
		Mechanism of Action
		Equipment
		Procedure
		Clinical Results
		Lesion Selection
	Orbital Atherectomy
		Mechanism of Action
		Equipment
		Procedure
		Lesion Selection
		Clinical Results
	Directional Coronary Atherectomy
	Cutting Balloon Angioplasty
		Mechanism of Action
		Equipment
		Technique
		Clinical Results
		Lesion Selection
		Complications
	Scoring Balloon Angioplasty
	Laser Angioplasty
		Technique
		Clinical Results
		Lesion Selection
36 - Supported Percutaneous Intervention
	Introduction and Rationale: Identifying the high-risk Patient
	Approach to the Patient
	Description of Devices and Available Clinical Data
		Intraaortic Balloon Pump
			Insertion Technique
			Clinical Trials
		Percutaneous Cardiopulmonary Support (CPS, ECMO)
			Insertion Technique
			Clinical Trials
		Percutaneous Left Ventricular Assist Devices
			Left Atrial–Femoral Artery Bypass
			Insertion Technique
			Clinical Trials
	Transvalvular Left Ventricular Assist Devices
		Insertion Techniques
			Clinical Trials
		Guidelines on Use of Hemodynamic Support Devices in High-Risk Percutaneous Coronary Intervention, Including Cardiogenic Shock
	conclusions
37 - Regional Centers of Excellence for the Care of Patients With Acute Ischemic Heart Disease
	INTODUCTION
	The Case for Regionalized Care
	Percutaneous Coronary Intervention Centers without on-Site Cardiac Surgery
	Benefits of Catheter-Based Therapy for Acute Coronary Syndromes
		ST-Elevation Myocardial Infarction
	Non–St-Segment Elevation Acute Coronary Syndromes
		Models of Regional Systems of Care
	Regionalization of Care for Cardiogenic Shock
	Limited Medical Resources
		Future Care of ST-Elevation Myocardial Infarction Patients
38 - Diagnosis and Treatment of Coronary Microvascular Disease
	Introduction
		Epidemiology of Coronary Microvascular Dysfunction
		Initial Workup of Coronary Microvascular Dysfunction
		Physiologic Basis of Functional Coronary Assessment
		Protocol for Functional Coronary Artery Assessment
			Approach
			Equipment
				Endothelial-Independent Microvascular Blood Flow
				Endothelial-Dependent Microvascular Blood Flow
				Alternative Measurement of Coronary Blood Flow
				Medications
			Adenosine
			Acetylcholine
			Nitroglycerin
				Procedural Safety
	Interpretation of the Test Results
		Suggested Therapies
		Treatment—Nonvasodilators
			Lifestyle Modification—Diet and Exercise
			Statins
		Treatment—Epicardial Vasodilators
			Nitrates
			Angiotensin Converting Enzyme Inhibitors
			β-Blockers
		Treatment—Microvascular Vasodilators
			Calcium channel antagonists
			L-Arginine
		Treatment—Microvascular Nonvasodilators
			Ranolazine
			Enhanced Extracorporeal Counterpulsation
	Conclusions
39 - Lower Extremity Interventions
	Epidemiology and Natural History
	Vascular Anatomy of the Lower Extremity
	Diagnosis of Lower Extremity Peripheral Arterial Disease
		History and Physical Examination
			Ankle-Brachial Index
			Pulse Volume Recording
			Segmental Blood Pressure
			Duplex Ultrasonography
			Computed Tomography Angiography
			Magnetic Resonance Angiography
			Contrast Angiography
	Interventions
		Iliac Artery Intervention for Inflow Disease
			Indications
			Revascularization Options
				Stent Choice
			Clinical Data
			Complications and Their Management
			When to Refer to Surgery
		Femoropopliteal Intervention for Outflow Disease
			Common Femoral Artery
			Indications
				Deep Femoral Artery
				Superficial Femoral Artery
			Stent Choice
			Specific Techniques: Laser, Atherectomy, SilverHawk
			Clinical Data
			Complications and Their Management
		When to Refer to Surgery
		Infrapopliteal (Runoff) Disease
			Indications
			Stent Choice
			Specific Techniques
			Clinical Data
			When to Refer to Surgery
	Acute Limb Ischemia
		Management Strategies of Acute Limb Ischemia
			Percutaneous Aspiration Thrombectomy
				Percutaneous Mechanical Thrombectomy
		Surgery
		Critical Leg Ischemia
		Interventional Treatment and Surgery
		Periprocedural Antithrombotic Therapy
		Post Peripheral Bypass Surgery Patient
	Miscellaneous Conditions
		Buerger Disease (Thromboangiitis)
		Peripheral Aneurysm
		Atheroembolism
	Conclusions and Future Directions
40 - Upper Extremities and Aortic Arch
	INTRODUCTION
	Epidemiology and Risk Factors for Peripheral Arterial Disease
	Vascular Anatomy of the Upper Extremity and Aortic Arch
		Normal Anatomy
		Anatomic Variants
	Diagnostic Evaluation and Disease Classification
		History and Physical Examination
		Laboratory Testing
		Vascular Laboratory Testing
		Catheter-Based Angiography
	Treatment
	Special Considerations
		Thoracic Outlet Syndrome
		Subclavian Steal Syndrome
		Coronary Steal Syndrome
	Conclusions
		Acknowledgments
41 - Chronic Mesenteric Ischemia: Diagnosis and Intervention
	Background
	Clinical Presentation
	Diagnosis
	Treatment
	Conclusion
42 - Renal Artery Stenosis
	Epidemiology and Natural History
	Pathophysiology of Renovascular Hypertension and Ischemic Nephropathy
	Diagnostic Tests and Imaging
		Ultrasonography
		Peak Systolic Renal Parenchymal Velocity
		Magnetic Resonance Angiography and Computed Tomography Angiography
	Functional Assessment of Renal Artery Stenosis
		Identification of At-Risk Patients and Indications for Renal Artery Revascularization
		CORAL Study
		Clinical Follow-Up
	Renal Endovascular Interventions
		Invasive Assessment of Renal Ischemia
		Renal Contrast Angiography
		Renal Artery Stenting
			Distal Protection Devices to Prevent Atheroembolization
			Management of In-Stent Restenosis
			Complications
		Percutaneous Renal Sympathetic Denervation to Treat Resistant Hypertension
43 - Device Therapy for Resistant Hypertension
	Definition and Epidemiology
		Renal Denervation: Science and Clinical Application
		Data Supporting Renal Denervation
			Preclinical Research
			Surgical Denervation for Hypertension Control
	Renal Artery Denervation
		Radiofrequency Ablation-SYMPLICITY Catheter and Clinical Evidence
			Efficacy
		Complications and Management of Radiofrequency Ablation in Renal Denervation
			Additional Radiofrequency Devices
		Multielectrode Radiofrequency Ablation
			Ultrasonic
		Tissue-Directed Pharmacological Ablation
		β-Radiation of the Renal Artery
	Alternative Approaches to Sympathetic Modulation
		Carotid Body and Sinus
		Mechanical Solutions
	Pacemaker-Mediated Programmable Hypertension Control Therapy
	Regulatory Trial Execution
	Matching Patients With Devices—Patient Selection
44 - Aortic Vascular Interventions (Thoracic and Abdominal)
	Aortic Dissection
		Indications for Endovascular Aortic Interventions
			Stable Acute Type B Aortic Dissection
			Unstable Acute Type B Aortic Dissection
			Chronic Type B Aortic Dissection
		Aortic Stent Graft Placement
			Retrograde Type A Thoracic Aortic Dissection
			Timing and Application of Endovascular Repair
	Descending Thoracic Aortic Aneurysm
		Endovascular Repair by Stent Grafts
			Technical Aspects of Endovascular Repair
		Hybrid Procedures for Aortic Arch Pathologies
		Clinical Experience
		Complications and Outcomes
	Abdominal Aortic Aneurysm
		Therapeutic Strategies
		Indications for Treatment
		Randomized Trial Data and Analysis
45 - Venous Intervention
	Introduction
	The Venous System: Basic Histology and Physiology
		Vein Valves
		Physiology
		Varicose Veins
		Chronic Venous Disease
		Superficial Vein Ablation
	Preoperative Evaluation and Preparation
		Medications
		Prophylactic Antibiotics
		Deep Vein Thrombosis Prophylaxis
		Planning Supplemental Procedures
		Compression Stockings
		Schedule Duplex Appointment
		Vein Mapping/Marking
	Procedure
		Perform Supplemental Procedures
	Follow-Up Care
		Pain Management
		Compression Stockings
		Postoperative Duplex Ultrasound
	Central Venous Stenosis—Superior Vena Cava Syndrome
		Diagnosis of Superior Vena Cava Syndrome
		Technique
		Stent Selection
		Complications
		Central Venous Stenosis—Inferior Vena Cava
			Anatomy and Symptoms
			Causes of Inferior Vena Cava Occlusion
			Diagnosis
			Treatment/Technique
	Deep Venous Thrombosis—Upper Extremity
		Diagnostic Testing
			Duplex Ultrasonography
			Magnetic Resonance Imaging
			Computed Tomography Venography
		Treatment Options
			Anticoagulation
			Thrombolytic Therapy
			Interventional Therapy
			Surgical Therapy
	Deep Venous Thrombosis—Lower Extremity
		Venous Duplex Ultrasound
			Intravascular Ultrasound
			Diagnostic Testing and Clinical Risk Stratification
		Goals of Therapy
		Catheter-Directed Thrombolysis
		Percutaneous Mechanical Thrombectomy
		The Research Gap in Deep Vein Thrombosis Intervention
		Inferior Vena Cava Filters
46 - Carotid and Cerebrovascular Intervention
	INTRODUCTION
	Carotid Bifurcation Intervention
		Carotid Bifurcation Atherosclerosis and Stroke
		Natural History of Carotid Artery Bifurcation Disease
		Benefit of Carotid Revascularization
		Percutaneous Carotid Revascularization
		Carotid Artery Stenting: The Procedure
			Preprocedural Assessment
			Baseline Angiography
			Interventional Technique
			Delivery of Sheath or Guide to the Common Carotid Artery
			Delivery of Embolic Protection Device
		Angioplasty and Stenting
			Predilation
			Stent Selection and Placement
			Postdilation
		Postprocedural Care and Follow-Up
	Complications of Carotid Intervention
		Stroke
		Hemodynamic Depression
		Hyperperfusion Syndrome
		Adverse Cardiac Events
		Restenosis
	Carotid Artery Stenting—Clinical Data
		Carotid Artery Stenting in High-Risk Patients
		Carotid Artery Stenting in Normal-Risk Patients
	Carotid Artery Stenting—Future Perspective
	Proximal Vertebral Artery Intervention
		Technique
		Endovascular Outcomes
	Intracranial Intervention
		Technique
		Clinical Outcomes
	Conclusions
47 - Stroke Centers and Interventional Cardiology
	Introduction
	New Imaging Strategies
	The Management of Physiologic Variables
		Hypertension
		Hypoglycemia
		Hyperglycemia
		Fever
	Reperfusion Strategies
		Intravenous Thrombolysis
		Intra arterial Thrombolysis
		Mechanical Thrombectomy
		Neuroprotection
	Stroke Centers
	The Role of Cardiology in a Stroke Program
48 - Imaging for Intracardiac Interventions
	Fluoroscopy and Angiography
		Left-Sided Structures
			Left Atrial Angiogram
			Left Ventriculogram
			Aortogram
		Right Sided Structures
			Right Ventriculogram
			Pulmonary Angiogram
	Transesophageal Echocardiography
	Intracardiac Echocardiography
	Computed Tomography and “Fusion” Fluoroscopy
		Specific Procedural Uses for Intracardiac Imaging
			Transseptal Puncture
			Patent Foramen Ovale
			Secundum Atrial Septal Defect
			Left Atrial Appendage Occlusion
			Mitral Valvuloplasty
			Aortic Valvuloplasty
			Pulmonary Valvuloplasty
			Percutaneous Mitral Valve Repair
			Percutaneous Aortic Valve Replacement
			Mechanical Prosthetic Valve Assessment
			Paravalvular Leak Closure
			Transcatheter Mitral Valve replacement
			Transcatheter Tricuspid Valve Repair and Replacement
49 - Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect
	Introduction
	Patent Foramen Ovale
		Embryology
		Incidence
		Cryptogenic Stroke
			Stroke Recurrence and Risk Identification
				Surgical Treatment
				Percutaneous Treatment
		Related Disorders
			Migraine Headache
			Platypnea-Orthodeoxia Syndrome and Hypoxia
			Decompression Sickness
		Diagnosis of Patent Foramen Ovale
		Closure Devices for Patent Foramen Ovale
			Amplatzer Patent Foramen Ovale Occluder
		Closure of Patent Foramen Ovale
			Indications
			Preprocedure Considerations
			Venous Access
			Crossing the Interatrial Septum
			Anticoagulation
			Measurement for Device Selection
			Delivery Sheath Insertion and Device Preparation
			Device Positioning and Release
			Postprocedure Care
				Prominent Chiari Network and Redundant Eustachian Valve
				Multiple Shunts
				Atrial Septal Aneurysms
				Lipomatous Hypertrophy of the Atrial Septum
			Complications
				Procedure-Related Complications
				Device-Related Complications
	Atrial Septal Defect
		Embryology
		Anatomic and Morphologic Considerations
		Clinical Presentation
		Hemodynamics
		Diagnosis
			Echocardiography
			Cardiac Catheterization
		Closure of Atrial Septal Defect
			Indications
			Devices for Percutaneous Closure
				Amplatzer Septal Occluder and Amplatzer Multifenestrated Septal Occluder Cribiform
				Gore Cardioform Occluder
			Procedural Details
			Complications
				Multifenestrated Atrial Septal Defects
				Multiple Atrial Septal Defects
				Atrial Septal Defect Closure and Pulmonary Hypertension
				Diastolic Left Ventricular Dysfunction and Atrial Septal Defect Closure
	Conclusions
50 - Left Atrial Appendage Closure and Stroke: Local Device Therapy for Cardioembolic Stroke Protection
	INTRODUCTION
	Atrial Fibrillation and Stroke
	Assessment of Thromboembolic and Bleeding Risk
	Oral Anticoagulation for Stroke Prevention
	Left Atrial Appendage Closure
		Rationale
		Surgical Approaches
		Transcatheter Approaches
			Percutaneous Left Atrial Appendage Transcatheter Occlusion System
				Implantation Procedure
				Clinical Data
			PROTECT-AF
			PREVAIL
				Meta-Analysis of Protect-AF and Prevail
				Watchman LAA closure in OAC-contraindicated patients
				Clinical Data
				Clinical Outcomes
	Patient Selection
	Conclusions
51 - Mitral Valvuloplasty
	Devices and Techniques
		Transseptal Approach
		Inoue Technique
		Other Techniques
	Monitoring the Procedure and Evaluating Results
		Monitoring the Procedure
		Immediate Results
			Failures
			Hemodynamics
			Complications
			Predictors of Immediate Results
			Long-Term Results
	Selection of Patients
		Patient Evaluation
		Assessment of Valve Anatomy
	Experience of the Medical and Surgical Teams
	Indications for Percutaneous Mitral Commissurotomy
	Future Prospects
52 - Percutaneous Mitral Valve Repair and Replacement
	Mitral Valve Disease
		Mitral Valve Anatomy
		Etiology and Mechanism of Mitral Regurgitation
		Natural History
		Imaging: Echocardiography
		Alternative Imaging Modalities
	Surgical Mitral Valve Repair
		Surgical Approach
		Isolated Annuloplasty
		Annuloplasty With Leaflet Repair
		Isolated Leaflet Repair with Edge-to-Edge Technique
		Percutaneous Mitral Valve Repair
		Edge-to-Edge (Double-Orifice) Leaflet Repair with the MitraClip System
			MitraClip for Degenerative Mitral Regurgitation
			MitraClip for Functional Mitral Regurgitation
	Annuloplasty-Based Mitral Valve Repair
		Indirect Annuloplasty
			Carillon Mitral Contour System
		Direct Annuloplasty
			Mitralign Direct Annuloplasty System
			Edwards Cardioband Annuloplasty System
		Cardiac Chamber Remodeling Devices
			AccuCinch Percutaneous Ventricular Repair System
			ARTO Septal Sinus Shortening System
			Coapsys and iCoapsys
			Basal Annuloplasty of the Cardia Externally
		Artificial Chord Implantation
			NeoChord DS1000 System
			Harpoon Mitral Valve Repair System
	Transcatheter Mitral Valve Implantation
		Transcatheter Mitral Valve Devices
			Tendyne Valve
			Medtronic Intrepid Valve
			Edwards CardiAQ
			Edwards SAPIEN M3
			LivaNova Caisson Transcatheter Mitral Valve Replacement
			Tiara Valve
			Surgical Bioprosthetic Valve or Valve Ring Failure
			Degenerative Mitral Stenosis
		Patient Selection
	Future Directions
53 - Balloon-Expandable Transcatheter Aortic Valve Replacement Systems
	Disclosures
	introduction
	Balloon Aortic Valvuloplasty
	Retrograde Approach: Equipment and Procedural Steps
		Cardiac Catheterization and Rapid Ventricular Pacing
		Balloon Preparation and Balloon Aortic Valvuloplasty
		Immediate Management After Balloon Aortic Valvuloplasty
	Antegrade Transseptal Approach
		Results Using Contemporary Balloon Aortic Valvuloplasty Techniques
	Current Perspectives of Balloon Aortic Valvuloplasty
		Background and Development of Transcatheter Aortic Valve Implantation
		Risk Stratification
		Patient Selection for Transcatheter Aortic Valve Implantation
			Cardiac Catheterization and Angiographies
			Echocardiography
			Computed Tomography
	Edwards Transcatheter Aortic Valves
		Edwards SAPIEN Valve
		SAPIEN XT Valve
		SAPIEN 3 Valve
			Anesthesia
				Infection and Antithrombotic Prophylaxis
				Venous and Arterial Access
				Aortic Angiography
				Temporary Pacemaker Placement
				Delivery Sheath Insertion
				Crossing the Aortic Valve
				Balloon Aortic Valvuloplasty
				Valve Insertion and Deployment
				Sheath Removal and Arteriotomy Closure
	Transapical Approach
		Direct Transaortic Approach
		Axillary Approach
		Transcaval Approach
	Clinical Results
		Historical Results
		Results of Recent Series (Table 53.4)
			Canadian Edwards Registry
			PARTNER European Registry
			SOURCE and SOURCE XT Registries
			PARTNER US Multicenter Pivotal Trial
			PARTNER 2 Trial
			PARTNER 3
				Transcatheter Valve Therapy Registry
		Complications After Balloon-Expandable Transcatheter Aortic Valve Replacement (Table 53.5)
			Stroke
			Heart Block
			Renal Dysfunction
			Severe Aortic Insufficiency
			Valve Embolization
			Vascular Complications
			Aortic Root Dissection and Annular Rupture
			Coronary Obstruction
	Balloon-Expandable Transcatheter Aortic Valve Implantation
	Conclusions
54 - Self-Expanding Transcatheter Aortic Valve Replacement
	INTRODUCTION
		CoreValve “Classic”
		Evolut-R, Evolut 34 mm, and Evolut-PRO Self-Expanding Design
		Anatomic Considerations
	Procedure Description
	Corevalve Clinical Studies Based on Surgical Risk
		CoreValve Extreme Risk Clinical Study
		CoreValve High-Risk Clinical Trial
		CoreValve Intermediate Risk Clinical Trial
		CoreValve Low-Risk “All Comers”
		Evolut Low Risk Trial
	Corevalve Expanded-Use Registries
		Alternative Access
		Failed Surgical Valves
		End-Stage Renal Disease
		Primary Aortic Regurgitation
		Low-Gradient Aortic Stenosis
		Bicuspid Aortic Valve Disease
		Transcather Valve Therapies Registry “Real World Outcomes”
	Complications After Self-Expanding Transcatheter Aortic Valve Replacement
		Predictors of Mortality
		Neurologic Injury
		Post–Transcatheter Aortic Valve Replacement Aortic Regurgitation
		Vascular Access Complications
		Conduction System Disturbances
		Coronary Artery Occlusion
		Acute Kidney Injury
		Leaflet Thickening and Thrombosis
	Predictors of Outcome
		Women
		Prior Coronary Artery Bypass Surgery
		Chronic Lung Disease
	Clinical Contraindications
	Potential Advantages of Self-Expanding Transcatheter Aortic Valve Replacement
		Hemodynamic Performance
	Improvements in Quality of Life
	Lotus Valve
	Symetis Acurate Neo
	Portico Valve
	Jena Valve
	Other Valve Prostheses
55 - Percutaneous Transcatheter Valve-in-Valve Implantation
	Background
	Surgical Bioprosthetic Heart Valves
	Sizing
	History
	Aortic Valve-in-Valve Procedure
		Preprocedural Planning
		Echocardiography
		Angiography
		Computed Tomography
	Multidisciplinary Heart Team Assessment
	Coronary Obstruction
	Aortic Valve-in-Valve Procedure
	Selection of a Transcatheter Heart Valve
	Positioning and Deployment of a Transcatheter Heart Valve
	Postdilation
	Outcomes After Aortic Valve-in-Valve Procedures
	MITRAL VALVE-IN-VALVE PROCEDURES
		Preprocedural Planning
		Sizing
		Outcomes
	Tricuspid and Pulmonary Valve in Valve Procedures
	Long-Term Durability
	Thrombosis Risk and Anticoagulation
56 - Pulmonary Valve Interventions
	introduction
	Percutaneous Pulmonary Valvuloplasty
		Background and Clinical Indications
	Procedural Technique
	Results and Outcome
	Percutaneous Pulmonary Valve Implantation
		Background and Clinical Indications
		Devices and Delivery Systems
			Melody Transcatheter Pulmonary Valve
			Sapien Pulmonic Transcatheter Heart Valve
		Patient Selection Criteria
			Clinical Criteria
		Preprocedural Assessment
			Morphologic Criteria
				Size and Shape of the Implantation Site
				Assessment of Coronary Artery Anatomy
				Exclusion Criteria
		Procedure
			Laboratory Setup
			Hemodynamic Assessment
			Morphologic Assessment
			Device Setup
			Device Implantation
				Prestenting of the Landing Zone. Prior to PPVI, prestenting with bare-metal stents may be helpful. Observational studies have fo...
					Postdilation of the Valved Stent. According to the Medtronic guidelines, postdilation of the valved stent is indicated if there ...
		Results
			Immediate Hemodynamic Outcome
			Immediate Procedural Complications
				Nature and Management of Stent Fractures
				Valved Stent Endocarditis
				Functional Outcome
		Extended Indications, New Valve Designs, and Future Directions
57 - Percutaneous Tricuspid Valve Repair
	INTRODUCTION
	The Tricuspid Valve Complex
	Pathophysiology of Tricuspid Insufficiency
	Imaging and Quantification of Tricuspid Insufficiency
	Transcatheter Approaches to Tricuspid Regurgitation
		Transcatheter Edge-to-Edge Repair of the Tricuspid Valve
			Summary of Clinical Evidence
			Procedural Approach
			Limitations and Challenges
		Intravalvular Coaptation Device: The FORMA Repair System
			Summary of Clinical Evidence
			Procedural Steps
		Annuloplasty-Based Devices
			Cardioband
			IRIS
			Trialign
			TriCinch System
		Caval Valve Implantation
	Transcatheter technique for degenerated tv bioprosthesis
		Summary of Clinical Evidence
		Valve-in-Valve Procedural Steps Using the Edwards Sapien S3
		Valve-in-Ring Procedural Steps
	Conclusion
58 - Hypertrophic Cardiomyopathy
	INTRODUCTION
	Epidemiology
	Natural History of the Disease
	Clinical Presentation
	Diagnosis
		Echocardiography
		Electrocardiography
		Magnetic Resonance Imaging
			Exercise Echocardiography
		Catheterization and Hemodynamics
		Genetic Overview
	Treatment
		Medical Therapy
			Verapamil
				Disopyramide
				Amiodarone
		Dual-Chamber Pacing
		Implantation of an Implantable Cardiac Defibrillator
		Surgery
		Septal Ablation
			Procedural Technique
	Conclusions
59 - Percutaneous Balloon Pericardiotomy for Patients With Pericardial Effusion and Tamponade
	Pericardial Effusion and Tamponade
	Pericardiocentesis
		Indications
		Technique
		Complications
		Postprocedural Management
	Percutaneous Balloon Pericardiotomy
		Technique
		Postprocedural Management
		Mechanism
		Results
			Evidence-Based Literature
		Technical Considerations
			Echocardiographic and Chest Radiographic Qualifications
			Prophylactic Antibiotic Administration
			Bleeding Risk
			Fluoroscopic Guidance
			Risks of Cardiac and Pulmonary Injury
			Pleural Effusion
			Duration of Catheter Placement
			Management of Balloon Rupture
			Adjunctive Diagnostic Approaches
	Novel Catheter-Based Interventions in the Pericardial Space
		Epicardial Mapping and Ablation
		Intrapericardial Echocardiography
		Percutaneous Pericardial Biopsy
		Pericardioscopy
		Percutaneous Left Atrial Appendage Suture Ligation
	Conclusions
60 - Transcatheter Therapies for Congenital Heart Disease
	INTRODUCTION
	Pulmonary Balloon Valvuloplasty
		Indications for Intervention
		Technique
			Infants
		Acute Results
			Adults
		Long-Term Results
		Complications
		Conclusions and Recommendations
	Aortic Balloon Valvuloplasty
		Indications for Intervention
			Infants
			Children and Young Adults
		Technique
			Newborn Critical Aortic Stenosis
		Acute Results
			Critical Aortic Stenosis
		Long-Term Results
			Critical Aortic Stenosis
		Complications
		Current Controversies
			Fetal Intervention
			Conclusions and Recommendations
	Balloon-Expandable Stenting for Pulmonary Artery Stenosis
		Technical Considerations
		Acute and Intermediate Outcomes
		Long-Term Outcomes
		Conclusions and Recommendations
	Balloon-Expandable Stenting for Coarctation of the Aorta
		Technical Considerations
		Clinical Outcomes
		Conclusions and Recommendations
	Transcatheter Closure of the Secundum Atrial Septal Defect
		Physiology
	Clinical Presentation and Diagnosis
		Treatment and Outcome
		Follow-Up
	Transcatheter Closure of the Patent Ductus Arteriosus
		Introduction
		Physiology
		Clinical Presentation and Diagnosis
		Treatment and Outcome
			Coils
			Duct Occluder Devices
		Follow-Up
	Transcatheter Pulmonary Valve Replacement
		Physiology
		Clinical Presentation and Diagnosis
		Treatment and Outcomes
		Technique
		Results
		Complications
	Conclusion
61 - Stem Cell Therapy for Ischemic Heart Disease
	Introduction
	Approaches to Cell Therapy
		Differentiated Cell Transplantation
		Myocardial Regeneration
		Bone Marrow-Derived Mononuclear Cells
	Novel Autologous Stem Cell Indications and Types
		Mesenchymal Stem Cells and Multipotent Adult Progenitor Cells
	Other Strategies for Delivery of Stem Cells to the Myocardium
		Cardiac Regeneration
	Stem Cell–Based Chemokine and Cytokine Strategies
	Electrical Effects of Cell Therapy
	Future Directions and Controversies
		Bench Investigation
		Clinical Investigation
		Strategies Beyond Simple Stem Cell Treatment That Could Move the Field Forward
	Conclusions
62 - Percutaneous Treatment of Paravalvular Leak
	Introduction
	Assessment of Paravalvular Leaks
	Outcomes
	Transcatheter Closure Versus Surgical Repair
		Practice Guidelines
	General Techniques
		Paramitral Defects
		Paraaortic Leaks
	Specific Techniques
		Double Wire—Simultaneous Deployment for Paramitral Leaks
		Anchor, Single Wire Technique—Sequential Deployment
		Modified Anchor Technique—Single or Sequential Deployment Using an Arteriovenous Rail
	Special Situations
	Complications
	Follow-Up
63 - Interventional Heart Failure
	Introduction
	Transcatheter Aortic Valve Replacement
	Percutaneous Mitral Valve Repair
	Percutaneous Tricuspid Valve Interventions
	Percutaneous or Hybrid Ventricular Partitioning or Restoration
	Interatrial Shunt Devices
	Implantable Hemodynamic Monitors
	Conclusions
64 - Qualitative and Quantitative Coronary Angiography
	Qualitative Angiography
		SYNTAX Score
		Risk Assessment Using Specific Lesion Morphologic Criteria
			Irregular Lesions
			Angulated Lesions
			Lesion Calcification
			Degenerated Saphenous Vein Grafts
			Thrombus
			Ostial Location
			Long Lesions
			Bifurcation Lesions
			Total Occlusion
		Angiographic Complications After Percutaneous Coronary Intervention
			Coronary Dissection
			No-Reflow Phenomenon
			Distal Embolization
			Coronary Perforation
			Coronary Spasm
			Abrupt Closure
			Stent Thrombosis
			Restenosis Pattern
			Late Aneurysm Formation
		Coronary Perfusion
			Thrombolysis in Myocardial Infarction Frame Count
		Coronary Flow Velocity
	Quantitative Coronary Angiography
		Nonquantitative Estimates of Lesion Severity
		Computer-Assisted Quantitative Coronary Angiography
			Cardiovascular Angiography Analysis System
			Coronary Measurement System
		Factors Contributing to Variability Using Quantitative Coronary Angiography
			Biologic Variability
			Acquisition Variability
			Measurement Variability
		Quantitative Angiographic Indices
			Lumen Improvements After Percutaneous Coronary Intervention
			Angiographic Success
			Binary Angiographic Restenosis
			Late Lumen Loss
			Limitations of Quantitative Coronary Angiography
			Three-Dimensional Imaging
65 - Intravascular Ultrasound
	INTRODUCTION
	Imaging Systems and Procedures
		Basic Principles
			Solid-State Dynamic Aperture System
			Mechanically Rotating Single-Transducer System
			Head-to-Head Comparisons
		Imaging Procedures
		Safety
	Image Interpretation
		Three-Layered Appearance of Arterial Wall
		Image Orientation
		Quantitative Measurements
		Plaque Composition on Gray-Scale Intravascular Ultrasound
		Advanced Tissue Characterization
			Radiofrequency Ultrasound Signal Analysis
	Diagnostic Applications
		Abnormal Lesion Morphology
		Unstable Plaque
			Gray-Scale Intravascular Ultrasound
			Advanced Tissue Characterization
		Serial Monitoring of Disease Progression or Regression
		Cardiac Allograft Vasculopathy
		Myocardial Bridging
	Interventional Applications
		Angiographic Lesion Ambiguity
		Intermediate Lesions
		Preinterventional Plaque Assessment
		Selection of Device Size and Length
		Common Stent Problems at Deployment
		Optimization of Stent Expansion
		Guidance for Complex Interventions
		Stent Problems at Follow-Up
			Restenotic Lesions
			Late-Acquired Incomplete Stent Apposition
			Strut Fracture
		Impact of Intravascular Ultrasound Guidance on Long-Term Outcomes After Stenting
		Bioresorbable Scaffolds
	Summary and Future Perspectives
66 - The Dynamic Spectrum of Coronary Atheroma: From Atherogenesis to Vulnerable Plaque to Plaque Regression
	The Dynamic Nature of Coronary Atheroma: From Atherogenesis to Plaque Regression
	Atherosclerotic Lesion Classification
		Mechanisms of Plaque Progression
			Oxidized Low-Density Lipoprotein and Inflammation in Atherogenesis
				Monocyte-Macrophages and T Cells in Atherosclerosis
			Resolution of Inflammation
			Defective Efferocytosis
			Vasa Vasorum Neovascularization
		Inflammation as a Promoter of Plaque Neovascularization
		Intraplaque Hemorrhage
			Defense Against Intraplaque Hemorrhage
		Haptoglobin Genotype
		Macrophage Interaction Between Iron and Cholesterol Homeostasis
	Vascular Remodeling and Thin-Cap Fibroatheroma
		The Concept of Thin Cap Fibroatheroma
			Clinical Significance of the Thin-Cap Fibroatheroma
		Large Plaque Burden and the Expansion Hypothesis
			Natural History of High-Risk Coronary Atheroma
	Intracoronary Imaging
		Intravascular Ultrasound
		Virtual Histology
		Optical Coherence Tomography
		Near-Infrared Spectroscopy
	Mechanisms of Plaque Regression
		Statin and Plaque Regression
		Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors and Plaque Regression
		Plaque Regression and PCSK9 Inhibitors
		Direct Antiinflammatory Therapy
		Additional Therapies
67 - Optical Coherence Tomography
	INTRODUCTION
	Physical Principles of Optical Coherence Tomography Imaging
	Image Acquisition
	Artifacts
	Image Interpretation and use
	Accuracy in Optical Coherence Tomography Measurements
	Current Clinical Application
		Assessment of Coronary Atherosclerosis
			Culprit Plaque Morphology
			Culprit Lesion Identification
			High-Risk Nonculprit Plaques
	Stent Assessment
		Optimal Versus Suboptimal Stent Implantation
			Strut Apposition
			Edge Dissection
			Strut Coverage
	Assessment of Stent Failure
		In-Stent Restenosis
		Stent Thrombosis
	Bioresorbable Vascular Scaffolds
	Oct-Guided Stent Procedures: Impact on Clinical Outcome
	Upcoming Technologies
		Future Advances in Optical Coherence Tomography
	Conclusions
68 - Medical Economics in Interventional Cardiology
	Introduction
	Medical Economics: Concepts and Methods
		Basic Concepts/Terminology
		Medical Economics Terminology
		Cost Measurement
			Evaluation of Procedure and Hospital Cost
			Evaluation of Physician Costs
			Factors That Impact Cost Assessment
		Analysis Methods
			Utility Assessment
				Time Horizon and Discounting
			Sensitivity Analysis
	Data Source for Economic Analysis and Decision Making
		Simulation With Markov Models
			Cost-Effectiveness Analysis With Patient Level Data
		Benchmarks in Economic Analysis
	Medical Economics of Coronary Interventions in Stable Coronary Artery Disease (Table 68.2)
		Cost Effectiveness of Medical Therapy Versus Revascularization
		Cost Effectiveness of Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Sta...
		Medical Economics of Reperfusion in ST-Elevation Myocardial Infarction
		Medical Economics of Early Invasive Versus Early Conservative Strategies in Patients With Non-ST Elevation Acute Coronary Syndro...
		Medical Economics of Antiplatelet Therapy
			Medical Economics of P2Y12 Receptor Antagonists
		Medical Economics of Antithrombotic Therapy Use in Non-STEMI Acute Coronary Syndrome
		Medical Economics of Antithrombotic Therapy Use in STEMI
	Medical Economics of Peripheral Vascular Interventions (TABLE 68.5)
		Cost Effectiveness of Noninvasive Therapy
		Cost Effectiveness of Percutaneous Transluminal Angioplasty Versus Bypass Surgery
		Cost Effectiveness of Technological Advances in Endovascular Interventions
	Medical Economics of Structural Cardiac Interventions (TABLE 68.6)
		Transcatheter Versus Surgical Closure of Secundum Atrial Septal Defects in Adults
		Medical Economics of Transcatheter Aortic Valve Replacement
			Cost Effectiveness of Percutaneous Mitral Valve Repair
		Economic Burden of Interventional Cardiology
69 - Quality of Care in Interventional Cardiology
	INTRODUCTION
	Efforts to Improve Quality in U.S. Medicine
	Quality in Interventional Cardiology
		Definition
		Therapeutic Development and Quality
	Judging Quality in Interventional Cardiology
		Structure
		Process
		Outcomes
	Building Blocks of Quality
		Clinical Practice Guidelines
		Performance Measures
		Outcome Measures
		Appropriate Use Criteria
		Recent Updates and Changes in Appropriate Use Criteria
		Impact of Guidelines, Performance Measures, and Appropriate Use Criteria
		Best Practices
		Quality Assurance and Continuous Quality Improvement
		Benchmarking
		Peer Review
	Developing A Quality Culture in the Cardiac Catheterization Laboratory
		Organizational Culture
		Physician Champions
		Tools to Assist in Quality Improvement
	Public Reporting and the Cardiac Catheterization Laboratory
		Effects of Reporting on Quality
		Potential Unintended Consequences of Public Reporting
		Improving Public Reporting
	Conclusions
70 - Volume and Outcome
	Introduction
	Evidence for a Volume-Outcome Relationship
		Public Policy Implications
	Conclusions