Complex Coronary Interventions — Advanced Techniques at QCG
When standard treatment isn't enough
Most coronary artery disease can be treated with standard angioplasty and stenting, which is a minimally invasive procedure to open blocked arteries. However, some patients present with more complex disease that requires advanced techniques and subspecialty expertise.
These cases include:
- Heavily calcified arteries — where the artery walls have hardened significantly, making standard stent deployment difficult
- Left main coronary artery disease — involving the main trunk artery that supplies the majority of the heart
- Long segments of disease — requiring treatment over extended lengths of the artery
- Critical side branches — where treatment must preserve blood flow to important branching arteries
- High-risk patients — where careful planning and multidisciplinary assessment are essential
At QCG, our interventional cardiologists have subspecialty fellowship training in these advanced techniques, allowing us to offer treatment options that may not be available at all centres.
Emergency: If you have chest pain that lasts for more than 10 minutes call Triple Zero (000).
Left Main Coronary Artery Disease
The left main coronary artery is the principal artery supplying the heart. It branches into the arteries that deliver blood to the majority of the heart muscle.
"The left main coronary artery is the main tree trunk coronary artery. It's a little bit more difficult to treat, not only because it's the most important artery in the heart, but also because of the location and the important branches that come off it."
Treatment of left main disease requires particular precision, including intravascular imaging to accurately size stents and specialised techniques to protect and maintain flow to the branching arteries.
"This is where subspecialty experience matters because the left main coronary is a very special artery that requires particular care and treatment. It is extra important to make sure we size our stents appropriately, land them accurately and try not to compromise other branches. Some tools that help us do this include imaging inside the artery."
For some patients, left main disease is best treated with coronary artery bypass surgery. For others, particularly those who may not be suitable candidates for surgery, catheter-based stenting is an option. The decision is made through careful multidisciplinary assessment.
Calcium Modification Techniques
As coronary artery disease progresses, calcium can build up within the artery walls. This calcium makes the artery rigid and resistant to standard balloon and stent treatment.
"Calcium doesn't just disappear. It stays in the artery and builds up.too. Because the calcium is very hard and not compliant to a stent opening it, to ensure we deploy a successful stent we must get rid of some of that calcium. This ensures a good long-term result."
QCG’s interventional cardiologists use several advanced techniques to treat calcified arteries:
Rotational Atherectomy
Rotational atherectomy uses a small, high-speed rotating burr to carefully remove calcium from the artery wall, creating space for a stent to be deployed effectively.
"Rotational atherectomy and orbital atherectomy are different tools used to drill, disrupt and crack calcium in the heart artery to make space for a balloon and stent”.
Intravascular Lithotripsy (Shockwave)
Intravascular lithotripsy is a newer technology that uses sound waves similar to the technology used to break up kidney stones, to crack and soften calcium deposits within the artery.
"Shockwave lithotripsy uses special sound wave technology. It uses similar sonic waves that break up calcium in kidney stones. We use a specialised balloon to deliver these waves in the coronary artery. This technique is relatively new. As it is gentler and safer than drilling, we are using this more and more”.
Orbital Atherectomy
Orbital atherectomy uses a small crown that orbits along the artery wall to sand away calcium deposits. Like rotational atherectomy, it prepares the artery for stent deployment.
"Before we use these specialised techniques, we benefit from extra training. Patients would not routinely require these to be performed, only in special cases. It is important we are trained to recognise when we need to use them, how to use them and how to manage things if they go wrong.”
Intravascular Imaging-Guided Procedures
For complex cases, QCG’s interventional cardiologists use intravascular imaging, by inserting a specialised camera or ultrasound probe into the artery to guide treatment decisions with greater precision than X-ray alone.
"Intravascular imaging involves taking special catheters that create high definition images of your arteries with ultrasound or light waves. It helps us measure the artery, define the type of plaque and help plan stenting."
Intravascular imaging is used to:
- Accurately measure artery dimensions for stent sizing
- Assess the location and severity of calcium deposits
- Confirm that stents have been optimally deployed
- Evaluate important side branches during complex procedures
" Based on a few research trials, people have better long-term outcomes if you use intravascular imaging."
Multidisciplinary Planning
Complex coronary cases at QCG are not treated in isolation. Before proceeding with advanced intervention, cases are reviewed collaboratively.
"For complex interventional cardiology procedures, we benefit from a period of planning and discussion before going to treatment because we want all the options to be explored. This might include looking at the pictures with a multidisciplinary team of interventional cardiologists and cardiothoracic surgeons to decide what the best lowest risk and long-term treatment is for that patient."
Recovery After Complex Procedures
Recovery from complex coronary interventions follows a similar pathway to standard stenting, though some patients may require a slightly longer hospital stay.
Frequently Asked Questions
Patients with heavily calcified arteries, left main disease, or complex anatomy that cannot be treated with standard angioplasty techniques. Your cardiologist will assess whether advanced techniques are required based on your imaging and clinical assessment.
While complex interventions carry a higher level of technical difficulty, they are performed by subspecialty-trained interventional cardiologists with dedicated fellowship training in these techniques. Careful planning and multidisciplinary review help minimise risk.
No. Complex coronary interventions are catheter-based and performed through a small incision in the wrist or leg, not open-heart surgery. For some patients, these techniques provide an alternative to bypass surgery.
To learn more visit:
- Coronary Angioplasty
- Coronary Angiography
- Coronary Artery Disease: qcg.com.au/common-cardiac-conditions/coronary-artery-disease/ [new page]
- Interventional Cardiology: [new page]
- CT Calcium Score
- Dr Maggie He
- Dr Alex Roati
What do I do if I have angina?
- As soon as you feel angina symptoms, immediately stop and rest.
- If rest alone doesn’t relieve the symptoms, take a dose of your angina medicine. Sit or lie down before using your spray or tablet, because it can make you dizzy. Use the smallest dose you normally take (e.g. a full, half, or even quarter of a tablet).
- Wait 5 minutes. If the angina is not relieved, take another dose of your angina medicine.
- Wait another 5 minutes.
- Talk – if someone is with you tell them how you’re feeling, or call a relative or friend.
- Call Triple Zero (000) if your angina:
- is not completely better within the 10 minutes you have waited;
- is severe;
- gets worse quickly.
Ask for an ambulance. Don’t hang up. Wait for advice from the operator.
Diagnosis
Your doctor may use one or more of the following tests to check if you have angina:
- Blood tests.
- Chest X-ray.
- Coronary angiogram.
- CT coronary angiogram (CTCA).
- Echocardiogram.
- ECG.
- Exercise stress test.
- Cardiac magnetic resonance imaging (CMRI).
