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viiiContributorsVasim Farooq, MBChB, MRCP, PhDInstitute of Cardiovascular SciencesManchester Academic Health Sciences CenterUniversity of ManchesterManchester Heart CenterManchester Royal InfirmaryCentral Manchester University Hospitals NHS TrustManchester, United KingdomJeffrey A. Goldstein, MD, FACC, FSCAIDirector, Vascular and Endovascular MedicinePrairie Cardiovascular ConsultantsDirector, Prairie Vascular FellowshipPrairie Cardiovascular ConsultantsChairman, Department of CardiologySaint John’s HospitalSpringfield, IllinoisKenneth Fetterly, PhDAssistant Professor of RadiologyDivision of Cardiovascular RadiologyMayo Clinic and FoundationRochester, MinnesotaHanney Gonna, MBBS, BSc, MRCPClinical Research FellowImperial Center of Translational and Experimental MedicineNational Heart and Lung InstituteImperial College LondonLondon, United KingdomPeter J. Fitzgerald, MD, PhDProfessor of Medicine and EngineeringDivision of Cardiovascular MedicineStanford University School of MedicineDirector, Center for Cardiovascular TechnologyCenter for Cardiovascular TechnologyStanford University Medical CenterStanford, CaliforniaMarat Fudim, MDCardiology FellowDepartment of Internal MedicineDuke UniversityDurham, North CarolinaValentin Fuster, MD, PhDPhysician-in-ChiefMount Sinai HospitalDirector, The Zena and Michael A. Wiener CardiovascularInstitute andThe Marie-Josée and Henry R. Kravis Center for CardiovascularHealthRichard Gorlin, MD, Heart Research Foundation ProfessorIcahn School of Medicine at Mount SinaiNew York, New YorkMario J. Garcia, MD, FACCChief, Division of CardiologyDepartment of MedicineMontefiore Medical CenterBronx, New YorkScot Garg, MB, ChB, MRCPDepartment of Interventional CardiologyErasmus Medical CenterRotterdam, NetherlandsBaris Gencer, MDFellowCardiology DivisionGeneva University HospitalGeneva, SwitzerlandBryan Goldstein, MDAssistant ProfessorPediatric CardiologyCincinnati Children’s Hospital Medical CenterCincinnati, OhioNilesh J. Goswami, MDDirector, Cardiac Catheterization LaboratoryPrairie Heart Institute at St. John’s HospitalSpringfield, IllinoisWilliam A. Gray, MDAssistant Professor of Clinical MedicineColumbia University College of Physicians and SurgeonsDirector, Endovascular ServicesColumbia University Medical Center/New York-PresbyterianHospitalNew York, New YorkGiulio Guagliumi, MDCardiovascular DepartmentAzienda Ospedaliera Papa Giovanni XXIIIBergamo, ItalyTrent Hartshorne, MBBS, FCICMCardiology Senior RegistrarFlinders Medical CentreAdelaide, AustraliaRani Hasan, MD, MHSAdvanced Fellow, Structural and Peripheral InterventionsInstructor in MedicineDivision of CardiologyJohns Hopkins UniversityBaltimore, MarylandTimothy D. Henry, MD, FACCDirector, Division of CardiologyProfessor, Department of MedicineCedars-Sinai Heart InstituteLos Angeles, CaliforniaHoward C. Herrmann, MDProfessor of MedicinePerelman School of Medicine of the University of PennsylvaniaDirector, Interventional Cardiology ProgramHospital of the University of PennsylvaniaPhiladelphia, PennsylvaniaDominique Himbert, MDCardiology DepartmentBichat HospitalParis, France

ContributorsRussel Hirsch, MDDirector, Cardiac Catheterization LaboratoryAssociate ProfessorUC Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnati, OhioDavid R. Holmes, Jr., MDProfessor of MedicineCardiovascular DiseasesMayo ClinicRochester, MinnesotaYasuhiro Honda, MDClinical Associate Professor of MedicineDivision of Cardiovascular MedicineStanford University School of MedicineCo-Director, Cardiovascular Core Analysis LaboratoryCenter for Cardiovascular TechnologyStanford University Medical CenterStanford, CaliforniaJavaid Iqbal, MBBS, MRCP (UK), PhDClinical LecturerDepartment of Cardiovascular ScienceUniversity of SheffieldSheffield, United KingdomBernard Iung, MD, FESCProfessor of CardiologyUniversity of Paris VIICardiology DepartmentBichat HospitalParis, FranceHani Jneid, MD, FACC, FAHA, FSCAIAssociate Professor of MedicineDirector of Interventional Cardiology ResearchBaylor College of MedicineDirector of Interventional CardiologyThe Michael E. DeBakey VA Medical CenterHouston, TexasJames G. Jollis, MD, FACCClinical Professor of MedicineNorth Carolina Heart and VascularUniversity of North CarolinaChapel Hill, North CarolinaMichael A. Jolly, MD, FACCInterventional CardiologistOhioHealth Heart and VascularColumbus, OhioDavid E. Kandzari, MDDirector, Interventional Cardiology and Interventional CardiologyResearchPiedmont Heart InstituteAtlanta, GeorgiaSamir R. Kapadia, MD, FACCDirector, Sones Catheterization LaboratoryCardiovascular MedicineCleveland ClinicCleveland, OhioAdnan Kastrati, MDProfessor of CardiologyGerman Heart Center and Medical Clinic Rechts der IsarTechnical University of MunichMunich, GermanyDean J. Kereiakes, MD, FACCMedical DirectorThe Christ Hospital Heart and Vascular Center and The LindnerResearch CenterProfessor of Clinical MedicineOhio State UniversityCincinnati, OhioMorton J. Kern, MDChief of MedicineDepartment of MedicineVA Long Beach Health Care SystemLong Beach, CaliforniaAjay J. Kirtane, MD, SMChief Academic OfficerDirector, Interventional Cardiology Fellowship ProgramColumbia University Medical CenterThe Cardiovascular Research FoundationNew York, New YorkAmar Krishnaswamy, MDInterventional CardiologyCleveland ClinicCleveland, OhioTakashi Kubo, MD, PhDAssistant ProfessorDepartment of Cardiovascular MedicineWakayama Medical UniversityWakayama, JapanJohn Lasala, MD, PhDProfessor of MedicineDivision of CardiologyWashington University School of MedicineDirector, Interventional CardiologyDivision of Interventional CardiologyWashington University School of MedicineMedical Director, Cardiac Catheterization LaboratoryBarnes-Jewish HospitalSt. Louis, MissouriScott M. Lilly, MD, PhDAssistant ProfessorInterventional CardiologyDivision of Cardiovascular MedicineOhio State UniversityColumbus, OhioMichael J. Lim, MDJack Ford Shelby Endowed ProfessorCo-Director, Center for Comprehensive Cardiovascular CareSaint Louis UniversitySt. Louis, MissouriWilliam L. Lombardi, MD, FACC, FSCAIAssociate Clinical Professor of MedicineDivision of CardiologyDirector, Complex Coronary Artery Disease TherapiesUniversity of Washington Medical CenterSeattle, Washingtonix

xContributorsPhilipp C. Lurz, MD, PhDDepartment of Pediatric Medicine/CardiologyUniversity of Leipzig–Heart CenterLeipzig, GermanyJane T. Luu, MD, MPHInterventional CardiologistStraub Clinic and HospitalHawaii Pacific HealthHonolulu, HawaiiBernhard Meier, MDProfessor and ChairmanCardiology DepartmentUniversity Hospital BernBern, SwitzerlandAdrian W. Messerli, MDAssociate Professor of MedicineDivision of Cardiovascular MedicineGill Heart InstituteUniversity of KentuckyLexington, KentuckyGilles Montalescot, MD, PhDProfessor of CardiologyPitié-Salpêtrière University HospitalInstitute of CardiologyParis, FrancePedro R. Moreno, MDProfessor of MedicineIcahn School of Medicine at Mount SinaiDirector, Interventional Translational ResearchMount Sinai HospitalNew York, New YorkJeffery W. Moses, MDProfessor of MedicineColumbia University Medical CenterDirector, Center Interventional Vascular TherapyNew York Presbyterian HospitalNew York, New YorkDebabrata Mukherjee, MD, FACC, FAHA, FSCAIChairman, Department of Internal MedicineChief, Division of Cardiovascular MedicineTexas Tech UniversityEl Paso, TexasSahar Naderi, MD MHSWomen’s Cardiology FellowDivision of CardiologyMassachusetts General HospitalBoston, MassachusettsSrihari S. Naidu, MDDirector, Cardiac Catheterization LaboratoryDivision of CardiologyWinthrop University HospitalMineola, New YorkAssociate Professor of MedicineSUNY Stony Brook School of MedicineStony Brook, New YorkBrahmajee K. Nallamothu, MD, MPHProfessor of Cardiovascular MedicineDepartment of Internal MedicineUniversity of Michigan Medical SchoolAnn Arbor, MichiganCraig R. Narins, MDAssociate Professor of Medicine and SurgeryDivisions of Cardiology and Vascular SurgeryUniversity of Rochester Medical CenterRochester, New YorkGjin Ndrepepa, MDProfessor of CardiologyGerman Heart CenterTechnical University of MunichMunich, GermanyFranz-Josef Neumann, MD, PhDEndowed Professor of Cardiovascular MedicineUniversity of FreiburgMedical DirectorDepartment of Cardiology and Angiology IIUniversity Heart Center FreiburgBad Krozingen, GermanyChristoph A. Nienaber, MD, FACCProfessor of CardiologyImperial College LondonThe Royal Brompton and Harefield TrustCardiology and Aortic CenterLondon, United KingdomIgor F. Palacios, MDProfessor of MedicineHarvard Medical SchoolDirector, Knight Catheterization LaboratoryInstitute for Heart, Vascular, and Stroke CareMassachusetts General HospitalBoston, MassachusettsTullio Palmerini, MDCardiovascular DepartmentS. Orsola General HospitalUniversity of BolognaBologna, ItalySeung-Jung Park, MD, PhDProfessorInternal MedicineUniversity of Ulsan College of MedicineAsan Medical CenterSeoul, South KoreaManesh R. Patel, MDAssociate Professor of MedicineDuke University School of MedicineDurham, North CarolinaUptal D. Patel, MDAssociate Professor of Medicine and PediatricsDivisions of Nephrology and Pediatric NephrologyDepartments of Medicine and PediatricsDuke Clinical Research InstituteDuke University School of MedicineDurham, North Carolina

ContributorsMarc S. Penn, MD, PhDDirector of ResearchSumma Cardiovascular InstituteSumma Health SystemAkron, OhioProfessor of MedicineIntegrative Medical SciencesNortheast Ohio Medical UniversityRootstown, OhioFemi Philip, MDAssistant Professor of Internal MedicineUniversity of California, DavisDavis, CaliforniaJeffrey J. Popma, MDDirector, Interventional Cardiology Clinical ServicesMedicine (Cardiovascular Division)Beth Israel Deaconess Medical CenterProfessor of MedicineHarvard Medical SchoolBoston, MassachusettsMatthew J. Price, MDAssistant ProfessorScripps Translational Science InstituteDirector, Cardiac Catheterization LaboratoryDivision of Cardiovascular DiseasesScripps ClinicLa Jolla, CaliforniaVivek Rajagopal, MDStaff CardiologistPiedmont Heart InstituteAtlanta, GeorgiaSunil V. Rao, MDAssociate Professor of MedicineDivision of Cardiovascular DiseasesDuke University Medical CenterDurham Veterans Affairs Medical CenterDuke Clinical Research InstituteDurham, North CarolinaSaurabh Sanon, MDAdvanced Structural Interventional Cardiology FellowDivision of CardiologyMayo ClinicRochester, MinnesotaJavier Sanz, MDAssociate Professor of Medicine (Cardiology) and RadiologyIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew York, New YorkBruno Scheller, MDDepartment of CardiologyDivision of Internal Medicine IIIUniversity of SaarlandHomburg/Saar, GermanyAlbert Schömig, MDProfessor of MedicineInternal Medicine and CardiologyMünchen, GermanyBeth Schueler, PhDAssociate ProfessorRadiology DepartmentMayo Clinic RochesterRochester, MinnesotaPatrick W. Serruys, MD, PhDProfessor of CardiologyErasmus Medical CentreRotterdam, the NetherlandsInternational Center of Circulatory HealthImperial CollegeLondon, United KingdomMehdi Shishehbor, DO, PhDDirector, Endovascular ServicesAssociate Program DirectorInterventional Cardiology FellowshipHeart and Vascular InstituteCleveland ClinicKausik K. Ray, BSc, MBChB, MRCP, MD, MPhil, FACC, FESCProfessor of Public HealthDepartment of Primary Care and Public HealthImperial College LondonLondon, United KingdomSatya S. Shreenivas, MDDirector, Center for Structural and Adult Congenital Heart DiseaseDivision of CardiologyUniversity of CincinnatiCincinnati, OhioG. Russell Reiss, MDDirector, Heart Valve Clinic and Transcatheter Valve TherapiesDivisions of Cardiovascular and Thoracic Surgery and CardiologyDean, St. Mary’s Cardiac CenterMadison, WisconsinKevin Silver, MDDirector, Coronary Intensive Care UnitSumma Cardiovascular InstituteSumma Health SystemAkron, OhioMarco Roffi, FESC, FACCVice-Chairman of CardiologyDirector, Interventional Cardiology UnitUniversity HospitalGeneva, SwitzerlandMitchell J. Silver, DO, FACC, FABVMInterventional CardiologistOhio Health Heart and VascularColumbus, OhioR. Kevin Rogers, MD, MScAssistant ProfessorVascular Medicine and InterventionInterventional CardiologyUniversity of ColoradoAurora, ColoradoDaniel I. Simon, MDChief, Division of Cardiovascular MedicineDirector, Harrington-McLaughlin Heart and Vascular InstituteHerman K. Hellerstein Professor of Cardiovascular ResearchUniversity Hospitals Case Medical CenterCase Western Reserve University School of MedicineCleveland, Ohioxi

xiiContributorsVasile Sirbu, MDCardiovascular DepartmentAzienda Ospedaliera Papa Giovanni XXIIIBergamo, ItalyPaul A. Sobotka, MDAffiliated Clinical ProfessorMedicine/CardiologyThe Ohio State UniversityColumbus, OhioGoran Stankovic, MD, PhDClinic for CardiologyDepartment for Diagnostic and Catheterization LaboratoriesClinical Center of SerbiaMedical School of BelgradeBelgrade, SerbiaCurtiss T. Stinis, MD, FACC, FSCAIDirector of Peripheral InterventionsDivision of Interventional CardiologyScripps ClinicLa Jolla, CaliforniaGregg W. Stone, MDProfessor of MedicineDivision of CardiologyColumbia University College of Physicians and SurgeonsDirector of Cardiovascular Research and EducationColumbia University Medical CenterNew York-Presbyterian HospitalThe Cardiovascular Research FoundationNew York City, New YorkDavid Suk, MDFellow, CardiologyDepartment of MedicineUniversity of California, IrvineIrvine, CaliforniaDeephak Swaminath, MDFellowSumma Cardiovascular InstituteSumma Health SystemAkron, OhioPaul S. Teirstein, MDChief of CardiologyDirector, Interventional CardiologyScripps ClinicDirector, Scripps Prebys Cardiovascular InstituteScripps HealthLa Jolla, CaliforniaOn Topaz MD, FACC, FSCAIProfessor of MedicineDuke University School of MedicineDurham, North CarolinaChief, Division of CardiologyCharles George Veterans AffairsAsheville, North CarolinaAlec Vahanian, FESC, FRCP (Edin.)Professor of CardiologyUniversity of Paris VIICardiology DepartmentBichat HospitalParis, FranceMiguel Valderrábano, MD, FACCAssociate Professor of MedicineWeill College of Medicine at Cornell UniversityNew York, New YorkChief, Division of Cardiac ElectrophysiologyDepartment of CardiologyHouston Methodist HospitalHouston, TexasAndres F. Vasquez, MDCardiology FellowCardiovascular MedicineThe University of Texas at HoustonHouston, TexasInterventional Cardiology FellowDivision of Interventional CardiologyWashington University Medical SchoolSt. Louis, MissouriAmit N. Vora, MD, MPHFellow, Cardiovascular DiseasesDepartment of MedicineDivision of Cardiovascular DiseasesDuke University Medical CenterDuke Clinical Research InstituteDurham, North CarolinaRobert Wagner, MD, PhDDepartment of Pediatric CardiologyUniversity of Leipzig-Heart CenterLeipzig, GermanyWilliam S. Weintraub, MDJohn H. Ammon Chair of CardiologySection of CardiologyChristiana Care Health SystemNewark, DelawareSandra Weiss, MDAssociate Program Director for ResearchSection of CardiologyChristiana Care Health SystemNewark, DelawareChristopher J. White, MD, MSCAI, FACC, FAHA, FESCProfessor and Chairman of MedicineThe Ochsner Clinical SchoolUniversity of QueenslandChief of Medical ServicesSystem Chair for Cardiovascular DiseasesMedical Director John Ochsner Heart and Vascular InstituteOchsner Medical CenterNew Orleans, LouisianaWendy Whiteside, MDAssistant ProfessorUC Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnati, OhioMathew R. Williams, MDAssociate ProfessorCardiothoracic Surgery and MedicineChief, Division of Adult Cardiac SurgeryDirector, Interventional CardiologyDirector, CVI Structural Heart ProgramNYU Langone Medical CenterNew York, New York

ContributorsPaul G. Yock, MD, MA, ABMartha Meier Weiland ProfessorBioengineering and MedicineStanford UniversityStanford, CaliforniaDavid A. Zidar, MD, PhDHarrington Heart and Vascular InstituteUniversity Hospitals Case Medical CenterCase Western Reserve School of MedicineCleveland, OhioAlan Zajarias, MDAssociate Professor of MedicineDirector, Structural Interventional Fellowship ProgramDivision of CardiologyWashington University School of MedicineSt. Louis, MissouriAndrew A. Ziskind, MD, MBAManaging DirectorClinical SolutionsHuron HealthcareAdjunct Professor of MedicineWashington UniversitySt. Louis, MissouriClinical ProfessorKellogg School of ManagementNorthwestern UniversityChicago, IllinoisJeffrey Zampi, MDAssistant ProfessorUC Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnati, OhioKhaled M. Ziada, MD, FACC, FSCAIGill Foundation Professor of Interventional CardiologyDirector, Cardiac Catheterization LaboratoriesDirector, Cardiovascular Interventional Fellowship ProgramGill Heart InstituteUniversity of KentuckyLexington, Kentuckyxiii

PrefaceThe seventh edition of Textbook of Interventional Cardiology hasbeen more extensively updated than any previous edition. We havetried to fully capture the excitement and relentless maturation of thefield of interventional cardiology. New chapters have been added toaddress radiation safety, interventions for heart failure, and (for manypatients) the lack of need for hospitalization after interventions. Overthe years, coronary intervention became increasingly predictable and,in many ways, routine, with the progressive maturation of stents andleaps forward in our adjunct pharmacologic therapies. In some ways,the field of interventional cardiology lost a bit of its pioneering sparkthat had so characterized this discipline from its inception in the 1980s.In those heady times, performing balloon angioplasty in the coronaryartery was unpredictable. The predictability provided by stents wasreplaced with the upredictability of stent thrombosis. Interventionalcardiologists and scientists had to not only rise to the challenge for eachindividual patient but also discover the vital innovations that wouldperpetuate the prominence and importance of the specialty.Today, the challenges continue, but they have morphed considerably. The profile of patients who undergo coronary intervention hasdramatically increased in complexity to include patients with advancedage and those with left main stem lesions, chronic occlusions, and whatwould formerly have been considered prohibitive complexity. Whatever happened to patients with Type A lesions? How can we break themaximal SYNTAX score barrier for percutaneous coronary intervention? At the same time, the crisis in health care economics has placedan undue burden on interventional cardiologists with respect to time,constraints in equipment selection, and fulfilling the responsibility of24/7 coverage for such emergencies as acute myocardial infarction.There is also the incremental pressure from scorecarding initiativesand challenges to the appropriateness or overuse of procedures. Buthopefully, all of these challenges are outweighed by the immensexivgratification of helping a symptomatic patient with limitations inquality of life get back to his or her baseline. Nowhere in medicine isthis feeling more prevalent than in the transformative field of transcatheter aortic valve replacement.This book is intended to serve as a resource for the interventionalcardiology community, which not only includes practicing cardiologists but also the team involved in procedures, referring physicians,and those training or who have aspiration to train in this awe-inspiringfield. We have changed authors for many chapters to provide a senseof newness and a fresh perspective, and in every chapter, we havesought the authors who are widely regarded as the true experts in thefield. Going forward, we fully recognize that there needs to be increasedcooperativity with cardiac surgeons—the rising popularity of hybridand collaborative valve procedures that capitalize on the best parts ofpercutaneous and surgical approaches is clearly indicative of thatcollaboration.We want to express our genuine and deep appreciation to theauthors from all over the wo

TEXTBOOK OF Interventional Cardiology 7TH Edition ERIC J. TOPOL, MD Gary and Mary West Endowed Chair of Innovative Medicine Professor of Genomics Department of Molecular and Experimental Medicine Director, Scripps Translational Science Institute Chief Academic Officer, Scripps Health Senior