65-year-old male with multiple CAD risk factors had moderate lateral wall ischemia on stress MPI and presented on May 18, 2012 with new onset CCS Class II angina. Cath revealed extensive 3V CAD and normal LV function: Syntax Score 30. Patient declined CABG after heart-team discussion and subsequently underwent successful PCI of multiple RCA lesions using three platinum-chromium everolimus drug-eluting stents and unsuccessful PCI of CTO LCx-OM2. He still has class I angina on maximal medical therapy. Patient is now staged for FFR-guided LAD PCI and re-attempt at LCx-OM2 CTO.
After watching the case, the learner should be able to:
- Discuss the appropriateness criteria for coronary revascularization.
- Explain the role of FFR during PCI.
- Discuss how a plaque modification strategy can be used as an adjunct tool during PCI.
Cardiologists, interventional cardiologists, fellows, and cardiovascular technicians.