LHX

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. 

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

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.

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.  

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.