CASE20210725_001

Intracoronary Imaging and Physiology Guided MVD PCI

By Yongbai Luo, Ning Guo
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Presenter

Yongbai Luo

Authors

Yongbai Luo1, Ning Guo1

Affiliation

The First Affiliated Hospital of Xi'an Jiaotong University, China1
Imaging - Physiologic Lesion Assessment

Intracoronary Imaging and Physiology Guided MVD PCI

Yongbai Luo1, Ning Guo1

The First Affiliated Hospital of Xi'an Jiaotong University, China1

Clinical Information

Patient initials or Identifier Number

LHX

Relevant Clinical History and Physical Exam

The patient was 59yrs, male. The chief complaint was paroxysmal chest pain for 5 years, aggravated for 2 weeks, he suffered anterior wall STEMI 4yrs ago, and received 2 stents implanted in LAD and PD. He had hypertension and type 2 diabetes. 

Relevant Test Results Prior to Catheterization

The patient received CCTA and the result show LM moderate stenosis.

Relevant Catheterization Findings

The CAG showed that diffuse moderate stenosis from LM to proximal LAD,  distal RCA was moderate stenosis too. The stents in LAD and RCA was patent.

Interventional Management

Procedural Step

FFR was performed to determined whether to intervention the 2 moderate stenosis or not. Firstly, we had pullback from LAD to LM, and the result show positive, then we checked the IVUS from LAD to LM, the IVUS showed very diffuse unstable plaque from LAD to LM, especially in the distal LM,  so we deployed stents from LAD to LM, the post FFR was acceptable, then we had evaluated the FFR of RCA, but the FFR was in grayzone, so we checked IVUS again, and the IVUS of RCA showed stable plaque, so we deferred the RCA.  

Case Summary

Coronary angiography cannot accurately assess the lesion sometimes, especially in diffuse disease.Both intracoronary imaging and physiology can further assess the severity of the lesion and help develop strategies.Post PCI physiology and imaging evaluation can optimize result and improve patient outcome.Combine using of  physiology and imaging may provide ideals to treat borderline lesion.