DEFERRED #PCI by #ANATOMICAL #PHYSIOLOGICAL & #IMAGING assessment - #TIPS & #TRICKS by Dr mohan

CASE SCENARIO :
1. Female / 52 years
2. Long standing DM / HTN / DYSLIPIDEMIA (15 years )
3. Abnormal rest ECG ( INCOMPLETE LBBB & inferior wall changes )
4. Normal LV function
5. SVT with Aberrancy - 1 episode outside ( 3 months before )
6. Morbid obesity -90 KG
7. ASCVD RISK SCORE - 6.1 % intermediate risk - Next 10 years
8. Indications for CAG - Class IIa

CAG ANALYSIS :
1. Single vessel CAD / Borderline - 70% lesion - Proximal LAD ( tapering vessel )
2. RDS

PLAN & ANALYSIS :
1. Invasive Physiology assessment & Image assessment & then revascularization
2. IC ADENOSINE -150 mics - RESTING FFR / HYPERAEMIC FFR / RFR / Pullback RFT - all above 0.92
3. OCT IMAGE DEEP ANALYSIS segment by segment - total Lesion length 15mm / MLA varies between 2.3 to 2.45mm2 about only 4.7mm length & remaining MLAs more than 2.5 mm2 / TCFA - not documented because above 600 microns / Plaque burden - 60-70% only 4.7mm & remaining below or around 50%
4. Why deferred PCI - even though 4.7 mm lesion length has 2.3-2.45 mm2 MLA , since Thick CFA & plaque burden less than 70%
5. So in my opinion negative FFR does rule out feature MI BUT if image shows TCFA with findings of less than 60microns likely or less than 20microns TCFA & length more than 10mm very very likely TO HAVE PLAQUE RUPTURE at the earliest .
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