When you cant wire coronary Ashish Shah 1

When you can’t wire coronary! Ashish Shah 1, Rito Mitra 2 1 University Hospital of Wales, Cardiff, UK 2 Royal Glamorgan Hospital, UK

History • 47 years old man • Hypertension, hypercholesterolemia, diabetes, current smoker • Under investigation for stable angina • Increased frequency of chest pain • Myocardial perfusion study • Lateral wall ischemia – perfusion • Coronary angiogram • Moderate diffuse disease

Coronary angiography

Coronary angiography

Fractional flow reserve (FFR) • Moderate diffuse disease • FFR – major epicardial vessels • Revascularization based upon FFR findings » At rest • LAD: • LCx: RCA: 0. 96 0. 88 0. 97 after 2 minute of IV adenosine 0. 84 0. 73 0. 85

PCI to LCx 1. Radi wire in AV circumflex 2. Multiple attempt to wire OM (big caliber than AV circumflex vessel, so wanted to wire and stent into OM, rather than AV circumflex), but failed

OCT

OCT

Course of OM • OCT demonstrated odd origin and course • OM starts lower and traversed along with the circumflex vessel upwards, before separating on its own course • Making it extremely difficult to wire • Stented proximal to OM vessel • Good final angiographic result.

Course of OM

summary and Conclusion • Coronary angiography • Not informative in defining ostium and course of OM vessel • OCT demonstrated course very well • Interventional strategy changed accordingly