CARE Checklist for 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 cm2 and indicative of stent deployment since the MLA was less than 3 mm2. 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: Figshare
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7084061161
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