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Dec 03, 2022 282 likes •400 views

ADVANCED CARDIOVASCULAR INTERVENTION ACI 2019 This case is brought to you by the ROYAL BLACKBURN HOSPITAL ADVANCED CARDIOVASCULAR INTERVENTION ACI 2019 Todays Team Claire Sheridan Michael Hindle Asma Patel Katie Shah (Nurse)

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ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

This case is brought to you by the ROYAL BLACKBURN HOSPITAL

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Ravi Singh Scot Garg John McDonald

Today’s Team

Katie Shah

(Nurse)

Claire Sheridan

(Nurse)

Michael Hindle

(Physiologist)

Asma Patel

(Radiographer)

ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

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Royal Blackburn Hospital

Catchment population of 520,000 Non-surgical centre with a PCI service which started in 2010 2 Cath labs (Siemens soon to be Philips) 4 PCI operators Volume 680-700 cases

35% Elective / 65% ACS split
Day case rate for elective PCI 85%
No on-site PPCI –patients transferred 24/7 to Blackpool (32 miles away)
CTO service (with Bridgepoint) volume – 50 cases
Radial rate >97%

24/5 PCI on-call (not for primary PCI)

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ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

STAGED PCI Patient MC

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q MC – 49 year old male Risk factors: Smoker, hypertension, T2DM, family history Previously well with no prior CV history 20/10/2018 - Anterior STEMI treated with PPCI to LAD (2 DES) with IVUS @ BVH

ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

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Referred to Blackburn for management of bystander disease and follow-up

ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

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Clinical Status Post STEMI

Exertional dyspnoea up inclines

Echo

Moderate LV impairment (hypokinetic inferior wall, akinetic anterior wall & normal lateral wall)

Dobutamine Stress echo

Viability in hypokinetic inferior segments No viability in anterior wall Ischaemia in infero-lateral wall ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

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Polling Question 1

What is your strategy for bystander disease post culprit artery PCI?

a. Don’t bother with anything unless symptomatic b. Treat all lesions at the time of index PCI c. Treat all lesions prior to discharge d. Elective PCI only if non-invasive assessment is positive e. FFR/iFR guided elective PCI irrespective of symptoms

ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

Vote now!

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Plan

iFR +/- FFR and IVUS guided PCI to the right coronary artery using Tri-registration

Rationale

Young male with an infarcted anterior wall and extensively diseased RCA, supplying a large territory of viable myocardium Use of technology to minimise excessive stenting and prevent full metal jacket

Challenges

Complete revascularization or symptom driven PCI post STEMI? Assessment of bystander disease Timing of staged PCI? Invasive assessment of tandem lesions ACI 2019

ADVANCED CARDIOVASCULAR INTERVENTION

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Polling Question 2

How do you proceed with a positive FFR/iFR in a vessel with multiple tandem lesions?

a. Repeat it several times and hope it becomes negative or falls in the grey zone b. Stent all the lesions and don’t repeat the FFR/iFR c. Stent the most severe lesion and repeat the FFR/iFR d. Use FFR/iFR pullback and treat the area with the largest step-up e. Use iFR pullback with co-registration to help you decide which lesion to stent

ACI 2019