Complex PCI represents one of the most challenging and rapidly evolving areas in interventional cardiology, encompassing advanced revascularization strategies for patients with high-risk anatomy, multiple comorbidities, and complex lesion characteristics. This session provides a deep, evidence-rich exploration designed for clinicians who manage left main disease, bifurcations, heavy calcification, chronic total occlusions, multivessel disease, severe tortuosity, degenerated grafts, and high-risk acute coronary syndromes. As interventionalists increasingly search for a specialized cardiology conference, this session brings together advanced techniques, contemporary algorithms, and real-world procedural insights to improve outcomes in difficult cases.

The description examines lesion preparation, intravascular imaging, hemodynamic optimization, and advanced equipment selection—elements essential for successful Complex PCI. Participants will learn how to navigate scenarios requiring rotational atherectomy, orbital atherectomy, laser atherectomy, IVL (intravascular lithotripsy), and dedicated bifurcation stent technologies. The session describes how contemporary imaging tools such as IVUS and OCT provide unparalleled visibility into plaque morphology, stent expansion, apposition, and optimization, enabling precise procedural decisions. Case-based analysis highlights step-by-step reasoning for choosing revascularization pathways, addressing complications, managing high thrombotic burden, and integrating physiology assessments such as FFR, iFR, and QFR.

A significant part of this session focuses on developing advanced Complex PCI strategies, emphasizing evidence-based approaches such as DK-crush, provisional stenting, double-kissing techniques, hybrid CTO algorithms, and hemodynamic support planning with devices like Impella or ECMO for high-risk PCI. The content also explores anticoagulation choices, strategies to reduce contrast nephropathy, radiation minimization, wire escalation, microcatheter use, and dual-access planning for highly complex CTO cases.

Participants will gain a deeper understanding of optimizing outcomes in patients with diabetes, left ventricular dysfunction, renal impairment, and frailty—ensuring individualized care plans for high-risk populations. The session also addresses shared decision-making, integrating surgical consultation, and using SYNTAX scores, heart team discussions, and functional imaging to determine when PCI or CABG is the preferred strategy.

The session concludes by examining emerging frontiers: robotic PCI, AI-assisted lesion interpretation, next-generation stent platforms, enhanced vessel preparation tools, physiologic imaging hybrids, and global trends shaping the future of complex revascularization. Clinicians will leave with practical frameworks for performing safer, more successful, and more predictable procedures in even the most demanding lesion subsets.