E-Case

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don¡¯t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-170

Again and Again

By Chun-Wei Lee

Presenter

Chun-Wei Lee

Authors

Chun-Wei Lee1

Affiliation

Mackay Memorial Hospital, Taiwan1,
View Study Report
TCTAP C-170
IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Physiologic Lesion Assessment

Again and Again

Chun-Wei Lee1

Mackay Memorial Hospital, Taiwan1,

Clinical Information

Patient initials or Identifier Number

50268235

Relevant Clinical History and Physical Exam

55 y/o M came with chest pain and cold sweating since 2 hours ago.Underline hypertension, heavy smoker 3-4PPD for 35+ years, COPD and hyperlipidemia.ECG showed anterior lead ST segment elevation myocardial infraction.

Relevant Test Results Prior to Catheterization

ECG showd anterior lead ST elevation

Relevant Catheterization Findings


TVD: LAD total              LCX-p 50%, OM2 80%             RCA-m 60%, RCA-d 70%
5.avi
3.avi
1.avi

Interventional Management

Procedural Step

We first rey to do the thrombosuction in LAD.However, during the precudure, No-reflow phenomenon attacked. We used adenosine but sudden bronchospasm and shock attacked.After intubation and inotropic agent, the patient regain TIMI 3 flow in LAD with some dissection in LAD.Initially, the patient decided to receieved CABG.However,  another episode of chest pain with hypotension attacked.Emergency CAG was performed, the patient decided to change his mind and will receieved PCI.We placed a DES in LAD(IRA), and used iFR for LCX and RCA.RCA showed insignificant iFR(0.95) value and LCX iFR value showed significant(0.75). W ethen placed a DES in LCX.
32 LAD stent ý­.avi
43 LCX stent ý­.avi
53.avi

Case Summary

Function test can still be useful in ACS especially when we need to decided whether it is a "true TVD" or not.For those who are not able to tolerate adenosine such as bradycardia, allergic to medication or bronchospasm patients, iFR is an effective way for function evaluation.