Tips, Tricks and Techniques for High-Risk PCI

Amir Kaki, MD, FACC, FSCAI discusses tips, tricks and techniques for high-risk PCI. In chapter 1, Dr. Kaki draws on his experience at one of the busiest centers in the country to address groin management, a common challenge for high-risk intervention patients. Learn his techniques in a didactic, step-by-step format. He also outlines an access technique protocol, which the team institutionalized for large bore sheath insertion, removal and complication management.

In chapter 2, Dr. Kaki shares his decision-making strategies for explantation of the Impella® heart pump, including a protocol to explant large bore access sheaths. Dr. Kaki also shares the strategies that he uses in the cath lab to ensure hemostasis after explantation.

In chapters 3 and 4 of this 4-chapter series, Dr. Kaki addresses decision-making strategies for management of complications at the groin access point, including management of perforation and handling of thrombotic complications. He outlines how his team maintains safe hemostasis. In chapter 4, Dr. Kaki outlines his strategies for handling sheath management in patients who are hemodynamically dependent on Impella, but the sheath is occlusive and the patient has lower limb ischemia.