Interventional Cardiology Fellowship

Interventional Cardiology fellows are taught the full range of interventional procedures. Emphasis is placed on learning as secondary/assistant operator and then primary operator, and ultimately as an independent operator, all under direct attending supervision.  Interventional fellows will graduate with proficiency in coronary interventions; select structural heart and peripheral vascular interventions based on availability within the given year. 

Proficiency is determined by successful completion of the requisite number of procedures as primary operator with documented technical success, and demonstration of pre-procedural, intra-procedural, and post-procedural cognitive abilities in managing interventional patients.  The interventional procedures taught in the cardiac catheterization laboratory include the following: 

Percutaneous coronary Interventions (PCIs)

Primary operator or co-operator 250 required. 

Coronary procedures/interventions

• Angioplasty – will count toward PCI total 
• Stent placement – will count toward PCI total 
• Chronic total occlusion intervention 
• Bifurcation stenting 
• Intravascular ultrasound/OCT 
• Fractional flow reserve 
• Rheolytic Angiojet thrombectomy
• Mechanical thrombectomy 
• Rotational atherectomy 
• IABP support 
• Impella support 

Peripheral/structural procedures/interventions

• Rotational atherectomy, directional atherectomy 
• Pioneer/outback re-entry techniques 
• SFA intervention  
• Iliac intervention 
• Renal intervention 
• Infrapopliteal intervention 
• Subclavian intervention 
• Intracardiac echocardiography (ICE) 
• Valvuloplasty (aortic, mitral, pulmonic) 
• ASD/PFO closure 
• Other 

Chronic ischemic heart disease - catheter-based interventions

• Selection of treatment modality (interventional, surgical, medical) 
• Pharmacotherapy 
• Percutaneous interventions 
• Angioplasty 
• Stent (BMS,DES) 
• FFR 
• IVUS, OCT 
• Niche devices 

Acute coronary syndromes and acute myocardial infarction

• Selection of treatment modality (interventional, surgical, medical) 
• Pharmacotherapy 
• Percutaneous interventions 

Recognition and management of hemodynamic compromise

• Hemodynamic assessment 
• Use of pharmacologic agents 
• Devices and procedures 
• IABP 
• Impella circulatory assist 
• Emergency pacing 
• Pericardiocentesis 
• Therapeutic hypothermia 

Catheter-based management in valvular and other structural disorders

• Hemodynamic and angiographic assessment 
• Mitral, aortic, tricuspid and pulmonic valve disorders 
• Hypertrophic cardiomyopathy 
• Utilize clinical, invasive and noninvasive findings 
• Differentiate patients who require surgical rather than percutaneous approaches 

Catheter-based management of adult congenital heart disease

• Interventional approaches to peripheral vascular disease, focusing primarily on diagnosis and patient selection 

Planning and execution of interventional procedures

• General decision making 
• Consideration of lesion subsets, patient characteristics and comorbidities 
• Alternatives to be used if an initial approach fails 

Selection and use of equipment

• Guiding catheters, guidewires, balloon catheters, niche interventional devices, including coronary stents, atherectomy, thrombectomy, embolic protection devices and ventricular support devices 

Use of antithrombotic agents

• Management of complications in interventional procedures (cardiac and non-cardiac) 

• Vascular biology, including the processes of plaque formation, vascular injury, vasoreactivity, vascular healing, restenosis, reperfusion injury, microvascular angina and effects of diabetes 
• Hematology, including the clotting cascade, platelet function and thrombolysis 
• Coronary and peripheral anatomy (normal and abnormal), lesion characteristics 
• Coronary physiology and myocardial function, including alterations in coronary flow due to obstructions in vessels; assessment and effect of flow dynamics on myocardial perfusion; function of collateral circulation; effect of arterial spasm or microembolization on coronary flow; left ventricular function, including stunning and hibernation; arterial pressure evaluation; right ventricular infarction; and shunt quantification 

• Biologic effects and appropriate use of vasoactive drugs, antiplatelet agents, thrombolytics, anticoagulants, antiarrhythmics, lipid-lowering agents, sedating agents, DES compounds, device-related pharmacology and local anesthetic agents 
• Biologic effects and appropriate use of angiographic contrast agents 

• Specific applications of imaging to interventional cardiology, including identification of anatomic features; visualization of lesion morphology by angiography and by intravascular and intracardiac ultrasonography; structural cardiac and peripheral vascular imaging (including echocardiography, MRI, and OCT) 
• Radiation physics, radiation risks and injury, and radiation safety, including methods to control radiation exposure for patients, physicians and technicians
• Equipment operation and imaging techniques 

• Ethical and legal issues, as well as risks associated with diagnostic and therapeutic techniques; includes patient consent and patient safety 
• Statistics, epidemiologic data and economic issues related to interventional procedures 

• Weekly Interventional Fellowship Core Curriculum Conference – Covers a comprehensive list of interventional cardiology milestones 
• Weekly cath lab conference
• Interventional Case Conference – Case-based didactic conference emphasizing quality angiography 
• Heart Alert Conference: Case-based conference designed to identify ways to improve rapid transport and optimal therapy for patients with STEMI 
• Best Practices Conference – Didactic presentations designed to review guidelines and critical evidence. 
• M&M conference: Cases with adverse outcome are reviewed in detail and discussed 
• Weekly Vascular Medicine Conference 
• Monthly Journal Club – An article of importance is presented by the fellow with discussion led by a designated faculty member 
• Monthly Research Conference – Planned, ongoing or completed research projects are discussed and presented by fellows and faculty