Role of imaging in complex PCI

Abstract

Background: The left main stem (LMS) disease is of critical importance due to its significant impact on myocardial perfusion. While coronary artery bypass grafting has historically been favored, advancements in percutaneous interventions offer viable alternatives. The evolution of stent technology, imaging modalities, and pharmacotherapy has expanded the scope of percutaneous treatment for LMS disease.

Case Presentation: A 45-year-old male with a history of diabetes and hypertension presented with chest pain and was diagnosed with Anterior Wall Myocardial Infarction (AWMI). After thrombolysis at a secondary care facility, he was referred to a tertiary care hospital where diagnostic assessments revealed severe LMS ostial stenosis and subtotal LAD artery occlusion. Despite initial plans for PCI targeting the LMS, subsequent intravascular ultrasound (IVUS) imaging led to a revised treatment strategy focusing on PCI to the LAD.

Results: Initial angiography suggested significant LMS disease, but IVUS revealed a different scenario, prompting a shift in the treatment plan towards PCI of the LAD. The procedure was successfully performed, with post-dilation confirming optimal stent expansion. Follow-up assessments demonstrated stable clinical status and improved cardiac function, indicating the efficacy of the intervention.

Conclusion: The case underscores the dynamic nature of coronary artery disease management and the pivotal role of advanced imaging techniques such as IVUS in refining treatment strategies. By adapting interventions based on evolving diagnostic assessments, optimal outcomes can be achieved, even in complex cases.