Decision-making in the absence of surgical option

Abstract

Background: The decision-making process in managing patients with multi-vessel CAD is multifaceted and must consider various factors, including anatomical complexity, patient preferences, and comorbidities. While CABG remains the gold standard for many patients, there is growing recognition of the role of PCI as a viable alternative, particularly in select patient populations.

Case Presentation: a 72-year-old non-diabetic, non-hypertensive ex-smoker, presented with angina categorized as CCS Class 2. A diagnostic angiogram in 2020 uncovered triple-vessel coronary artery disease (TVCAD), prompting deliberation regarding surgical or percutaneous intervention. However, patient declined surgical options, leading to the pursuit of multi-vessel PCI.Patient exhibited mild mitral and aortic regurgitation, a reversed E/A ratio indicative of diastolic dysfunction, and no regional wall motion abnormalities on echocardiography. His laboratory results were unremarkable.

Management and Results: Multi-vessel PCI was conducted as patient's therapeutic choice. The procedure targeted TVCAD and aimed to ameliorate symptoms. Following PCI, echocardiographic evaluations showcased stability and preservation of cardiac function.

Conclusion: This case emphasizes the viability of multi-vessel PCI as an alternative in instances of surgical refusal, offering relief from symptoms and safeguarding cardiac function. This case highlights the importance of tailored interventions and shared decision-making in managing complex coronary artery disease scenarios.