16 May 2023
Management of complex non-culprit multivessel disease after STEMI - LIVE case
Non-left main calcified bifurcation treated with IVUS-guided lithotripsy
Summary
Analyze the case of a 69-year-old non-diabetic male patient with mild chronic kidney disease, acute inferior MI and primary PCI on the postero-lateral RCA, whose angiography showed diffuse disease on the proximal CX and second OM (QFR: 0.65), and an intermediate prox LAD lesion (QFR: 0.90).
IVUS showedcircumferential calcification around the bifurcation, between the first and second marginals.
The lesion was prepared by lithotripsy, then provisional stenting (kissing and POT) was performed, and a stent was placed on the prox CX. A final POT was performed on the basis of IVUS images.
LIVE Case from Clinique Pasteur, Toulouse - France
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Key moments
- 25:13 - 28:21 - Pre-PCI IVUS
- 28:40 - 39:00 - Lithotripsy
- 01:10:30 - 1:12:46 - Post-stent IVUS
- 01:19:14 - 01:20:00 - post-POT IVUS
Key words: Non left main bifurcation, Calcified lesion, IVUS, Lithotripsy, Provisional stenting
Learning Objectives
- To reflect on the indications and timing of non-culprit multivessel disease revascularisation after STEMI
- To understand the respective roles of imaging and physiology guidance for revascularisation in this setting
