2- Centre information Eligibility criteria Centre information FOR INTERNAL USE ONLY Technology chosen by the Intra coronary imaging □ candidate Fractional flow reserve □ Bifurcation PCI □ Radial approach □ PCI in STEMI / NSTEACS □ Rotational atherectomy □ Revascularization of chronic total □ occlusion Interventions using bioabsorbable □ scaffolds Transcatheter aortic valve replacement □ □ Mitral valve interventions (Mitral valvuloplasty, MitraClip, Novel devices) Left atrial appendage closure □ Atrial septal interventions □ Extensive experience with Please provide figures the chosen technology Dedicated mentor has to be □Yes identified and linked to each No □ hosted fellow Name of the mentor: Capable to expose the Number of procedures to which the candidate with high volume candidate is expected to be exposed: during the visit ….. Optical coherence Please provide centre numbers tomography 20 cases / 4w – Intracoronary Ultrasound Please provide centre numbers – 20 cases / 4w Fractional flow reserve 25 Please provide centre numbers – cases / 4w
2- Centre information Eligibility criteria Centre information FOR INTERNAL USE ONLY Technology chosen by the candidate □ Intra coronary imaging □ Fractional flow reserve □ Bifurcation PCI □ Radial approach □ PCI in STEMI / NSTEACS □ Rotational atherectomy □ Revascularization of chronic total occlusion □ Interventions using bioabsorbable scaffolds □ Transcatheter aortic valve replacement □ Mitral valve interventions (Mitral valvuloplasty, MitraClip, Novel devices) □ Left atrial appendage closure □ Atrial septal interventions Extensive experience with the chosen technology Please provide figures Dedicated mentor has to be identified and linked to each hosted fellow □Yes □ No Name of the mentor: Capable to expose the candidate with high volume during the visit Number of procedures to which the candidate is expected to be exposed: ….. Optical coherence tomography – 20 cases / 4w Please provide centre numbers Intracoronary Ultrasound – 20 cases / 4w Please provide centre numbers Fractional flow reserve – 25 cases / 4w Please provide centre numbers
EAPCI%20Form%20-%20Microfellowship.docx