Lésions étagées de la CD et lésion IVA

• 62 years old female
• CVRF : arterial hypertension
• ACS presentation 3 weeks ago in stress context. 
• At admission (no chest pain)
  ECG :  ST segment depression in lateral leads
  Troponine positive (7 ng/ml)
  Echocardiography  : LVEF = 35% with apical bollooning.

Learning points

• Functional  evaluation by FFR in coronary multivessels disease. 
• FFR in serial multiple lesions in the same vessel. 
•  Additional diagnostic  value of intracoronary imaging by OCT in case of borderline FFR result. 

Procedure description

• 6Fr JR guiding catheter in the RCA.
• FFR recording to the distal RCA ( two lesions, FFR:0.87)
• Pullback pressure recording.
• FFR recording to the LAD ( two FFR values : 0.81 and 0.80).
• OCT run to the LAD showing significant  lipid-Rich plaque.
• Stent implantation in the proximal LAD Xience Alpine 3.5x15mm.
• OCT and FFR control  runs.

Protocol

• Time of procedure: 16 min.
• Radiation exposure: 0.51 Gy. 
• Contrast volume: 190 ml Iomeon)