Work

Case Report: Seeing-is-Believing: Integrating Physiology and Intracoronary Imaging for Resolving the Revascularization Conundrum of Diffuse and Calcified Coronary Lesions

Year: 2025

Type: article

Abstract: A diffuse and heavily calcified coronary lesion represents a complex clinical scenario, often leading to suboptimal outcomes. The optimal management, whether percutaneous coronary intervention, surgery, or medical treatment, remains debatable. A 64-year-old male was referred to our outpatient clinic with persistent typical chest pain. Coronary angiography revealed diffuse and heavily calcified lesions with 75% stenosis at the proximal to middle LAD. A physiological assessment was performed using a hybrid approach of resting full-cycle ratio (RFR) and fractional flow reserve (FFR). Initial RFR was inconclusive (0.91). Follow-up FFR measurement supported the indication for stenting. Lesion characterization using intracoronary optical coherence tomography (OCT) showed a thick, long, and heavily calcified lesion with an OCT Calcium score of 4. The minimal lumen area (MLA) was only 1.78 cm 2 and indicative of stent deployment since the MLA was less than 3 mm 2 . Three runs of rotational atherectomy were performed, followed by non-compliant balloon dilatation and two DES implantations. The procedure was successful with TIMI flow grade 3 and optimal OCT evaluation. The combination of hybrid physiological assessment and intravascular imaging is an effective and efficient strategy for managing complex diffuse-calcified coronary lesions.

Source: F1000Research

DOI: 10.12688/f1000research.167119.1

Authors: Suryo Ardi Hutomo, Kevin Luke, Aldhi Pradana Hernugrahanto, I Gde Rurus Suryawan, Yudi Her Oktaviono

Institution: Universitas Airlangga

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,350