Coronary Physiology

Case 1

A 67-year-old Caucasian man with PMH significant for PTCA of an unspecified vessel >20 years ago was referred for left heart catheterization with diagnostic coronary angiogram +/- PCI. His symptoms included intermittent (left-sided) chest pain that would occur primarily at rest. He underwent a treadmill stress echocardiogram, which did not reveal any ECG or echocardiographic evidence of inducible ischemia after completing 6 minutes, 36 seconds  and achieving >85% of APMHR on the Bruce protocol.

A left transradial approach was used for this procedure with a 6 French system. After both FFR and iFR evaluation of the LAD (iFR pullback shown) confirmed that the mid lesion was functionally significant, the decision was made to proceed with orbital atherectomy-assisted PCI of the mid LAD with deployment of a Boston Scientific SYNERGY 3.0 x 20 mm (everolimus) drug-eluting stent. Orbital atherectomy  involved three 30-second ablation runs at 80,000 rpm followed by two ablation runs at 120,000 rpm. The stent was post-dilated proximally to ~3.9 mm. The patient was able to ambulate two hours following the end of the procedure and was discharged home the next day.