Complex High-Risk Indicated Patient (CHIP) Interventions

Review Paper | 2026 | Volume 2 | Issue 1 | Page 78 - 83

Dr. Amali Singh Tanuja, Assistant Professor, Department of Cardiology, GMC, Sis UP

Abstract

The clinical landscape

Complex High-Risk Indicated Patient (CHIP) Interventions.

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of interventional cardiology is increasingly defined by the CHIP (Complex High-Risk Indicated Patient) population—a cohort characterized by complex coronary anatomy, severe hemodynamic compromise, and multiple systemic comorbidities. Historically, these patients were often deemed "inoperable" or "un-treatable" by traditional surgical and interventional standards. This chapter evaluates the modern "NextGen" approach to CHIP interventions, which integrates advanced mechanical circulatory support (MCS) with sophisticated lesion-debulking technologies. We examine the methodology of "Protected PCI," utilizing devices such as the Impella and Intra-Aortic Balloon Pump (IABP) to maintain hemodynamic stability during high-risk maneuvers. A primary focus is placed on the technical management of Chronic Total Occlusions (CTO) and Severely Calcified Lesions, utilizing the latest iterations of Intravascular Lithotripsy (IVL) and Rotational/Orbital Atherectomy. Furthermore, the chapter discusses the crucial role of the Heart Team in risk stratification, using the SYNTAX II and STS scores to balance the benefits of complete revascularization against the procedural risks. By synthesizing data from 2024–2026 registries, this chapter illustrates how the synergy of operator expertise, intravascular imaging, and mechanical support has transformed "prohibitive-risk" scenarios into predictable, life-saving procedures. As we look toward 2030, CHIP interventions signify the ultimate maturation of the cath lab—where no patient is left without a therapeutic option.