Optimizing PCI Results with Integrated NIRS-IVUS and X-ray
A 50-year-old female patient with no prior cardiac history presented to the emergency department with new onset chest pain. Her initial electrocardiogram and troponin were normal. A coronary CT angiogram demonstrated a stenosis in the proximal right coronary artery (RCA). To further evaluate the significance of this stenosis, we performed a stress echocardiogram. At low-level stress, she developed an inferior wall motion abnormality consistent with severe RCA disease. She was referred to the catheterization laboratory for invasive angiography and possible intervention. Initial angiography revealed culprit lesions in the proximal and mid-RCA. The proximal RCA stenosis was pre-dilated with a 2.0 mm balloon to facilitate passage of the NIRS-IVUS catheter. Consistent with the concept that lipid core plaques are responsible for most acute coronary syndromes, the culprit lesion in the proximal RCA was characterized by NIRS to have a large lipid core (maxLCBI4mm=400). IVUS was used prior to stent placement to determine reference vessel size and lesion length. The culprit lesion in the proximal RCA was treated with a drug-eluting stent. The severe stenosis in the mid-RCA was also treated with a drug-eluting stent. NIRS-IVUS was repeated after the intervention for stent optimization, and the IVUS images demonstrated that both stents had adequate expansion and good strut apposition.