What Does "Advanced" Mean?
Advanced coronary care is about more than treating blockages. While some heart artery narrowings are straightforward, others are more complex and require specialised expertise.
Advanced interventional techniques use modern, minimally invasive approaches to treat difficult or long-standing coronary blockages with careful attention to safety, often without the need for open-heart surgery, with the goal of improving symptoms and quality of life. Like all procedures, these carry risks, which are higher for complex blockages; your cardiologist will discuss them with you.
Angiograms and stents in brief
An angiogram is an X-ray test in which a thin tube is passed from the wrist or groin to the heart and dye shows the arteries. If a narrowing needs treatment, a stent (a small mesh tube) can often be placed during the same procedure. Serious complications such as stroke, heart attack or emergency surgery occur in well under 1 in 100 people having a planned angiogram, but your cardiologist will discuss your own risk.
Why Experience Matters
Complex coronary procedures are not about using one technique. They require the ability to select and combine different approaches depending on the anatomy, the blockage, and the patient.
Experience means knowing:
- Which technique is most appropriate
- When to change strategy mid-procedure
- When not to proceed
- How to manage challenges and complications safely
This level of decision-making comes from dedicated training and experience.
A Full Toolkit, Used Thoughtfully
Dr Ng is trained in a wide range of advanced coronary techniques, including:
Advanced Wire Techniques
Modern wire and catheter techniques for crossing difficult or long-standing blockages.
CTO Recanalisation
Specialised techniques to reopen long-standing complete blockages using contemporary approaches.
Calcified Artery Treatment
Strategies for calcified arteries that require expert management and advanced techniques such as lithotripsy and atherectomy.
Imaging-Guided Precision
Advanced imaging to guide precise stent placement and optimise procedural outcomes.
Safety-First Methods
Methods to improve safety and protect heart muscle during complex procedures.
Complication Management
Experience and advanced skills to respond promptly to complications when required.
Safety Always Comes First
Not every blockage should be treated, and not every procedure should be pushed to completion. A careful approach prioritises careful planning, clear stop points, calm management of complications, and long-term benefit over technical success alone.
What This Means for You
For patients, advanced techniques are not about complexity for its own sake. The aim is better symptom relief, fewer repeat procedures, safer treatment and a better quality of life.
For GPs
- Who benefits from complex-PCI referral: persistent angina despite optimal medical therapy with CTO, heavy calcification, left main or bifurcation disease, stent failure, or patients declined for or preferring to avoid CABG after heart-team review. (ESC 2024 CCS)
- Heart team: multivessel or left main disease should be discussed at a heart team meeting before a non-urgent procedure.
- Pre-referral work-up: FBC, UEC/eGFR, HbA1c, lipids, ECG, echo, and any CTCA or functional test. Flag contrast allergy, anticoagulants, metformin and SGLT2 inhibitors.
- Antithrombotics around procedures: continue aspirin before an angiogram unless told otherwise. Anticoagulant interruption is decided by the proceduralist; DOACs do not need heparin bridging.
- After discharge: confirm the DAPT stop date in the letter, check a PPI is prescribed, and refer to cardiac rehabilitation.
General information for referring practitioners. Check current MBS and PBS criteria before acting.