Dear colleagues,

Welcome to this month’s edition of the TCTMD CHIP newsletter, which follows an incredibly exciting and successful CTO Plus 2023 meeting in New York!

This month’s newsletter begins with an excellent discussion on the use of invasive and non-invasive physiology to guide patient management. In his case-based discussion, Amir Kaki, MD (St. John Hospital and Medical Center, Detroit, MI), clearly illustrates how real-time, non-invasive physiology assessment contributes to revascularization decision-making. He takes us from the angiogram through physiologic assessment all the way to a discussion of surgery versus PCI, supported by contemporary data. This presentation provides an excellent blueprint for physiology-based revascularization decision making, including post-PCI result assessment, and is not to be missed!

Next, Khaldoon Alaswad, MD (Henry Ford Hospital, Detroit, MI), presents complex PCI cases aided by the use of percutaneous mechanical circulatory support (pMCS). In his discussion, he defines the outcome differences between planned and emergency pMCS in high-risk PCI, discusses patient selection considerations, and reviews the PROGRESS CTO MCS score to help guide patient selection in pMCS supported CTO PCI.

Thereafter we move to complication management with John Graham, MD (St. Michael’s Hospital, Toronto, Canada). In his exceptional discussion of perforation management, Dr. Graham presents a novel approach to classifying coronary artery perforations: The Extravasation-Site-Patency (ESP) approach. This approach elegantly defines key assessment parameters and technical considerations in coronary perforation management, focusing on clinical utility and practicality. The application of this novel and teachable approach is then highlighted using several cases. This is another “must-see” talk.

Finally, Kate Kearney, MD (University of Washington, Seattle, WA), expertly reviews the most important data supporting the benefits (and optimization) of complex PCI. Dr. Kearney defines the outcomes associated with complex and high-risk PCI and highlights the improvements in quality of life associated with successful revascularization. She reviews the results of several important studies, including the BCIS Registry and REVIVED, in detail and highlights both important findings and caveats in the interpretation of their conclusions. In her look ahead, Dr. Kearney introduces a novel pMCS support technology and underscores the potential benefits of continued innovation in this space.

This month’s live case recordings feature cases from Columbia University Medical Center in which several excellent CTO cases are treated live. Techniques, technology, and discussion–all richly present in these great cases for your review and enjoyment.

We hope you have found this month’s TCTMD CHIP newsletter interesting and informative. Stay tuned for more great content in the months ahead!

Robert F. Riley, MD, MS and Sanjog Kalra, MD, MSc (Co-Editors)

Ajay J. Kirtane, MD, SM (Senior Editor)