Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-169
Instant Wave-Free Ratio Guided Decision Making in a Coronary Artery Disease Patient Prior to Kidney Transplant
By Antonia Anna Lukito, Riyandi Ardi Putra Fernandes, Hardi Hutabarat, Sonia Chandra, Audie Christopher
Presenter
Riyandi Ardi Putra Fernandes
Authors
Antonia Anna Lukito1, Riyandi Ardi Putra Fernandes1, Hardi Hutabarat1, Sonia Chandra1, Audie Christopher1
Affiliation
Siloam Hospitals Lippo Village, Indonesia1,
View Study Report
TCTAP C-169
IMAGING AND PHYSIOLOGIC LESION ASSESSMENT - Physiologic Lesion Assessment
Instant Wave-Free Ratio Guided Decision Making in a Coronary Artery Disease Patient Prior to Kidney Transplant
Antonia Anna Lukito1, Riyandi Ardi Putra Fernandes1, Hardi Hutabarat1, Sonia Chandra1, Audie Christopher1
Siloam Hospitals Lippo Village, Indonesia1,
Clinical Information
Patient initials or Identifier Number
Mr. BK
Relevant Clinical History and Physical Exam
A 63-year-old hypertensive with end stage renal disease male, referred for coronary evaluation prior to kidney transplant. No remarkable findings on physical examination. The medications are amlodipine/telmisartan 10/ 160 mg and bisoprolol 2.5 mg.
Relevant Test Results Prior to Catheterization
ECG showed a normal sinus rhythm, 65 bpm, left atrial enlargement and left ventricular hypertrophy. Echocardiography revealed dilated LA and LV hypertrophy, mild mitral and aortic regurgitation with normal left ventricular ejection fraction without any regional wall abnormality. Laboratory results were significant of hemoglobin 10.2 mg/dL, ureum 104 mg/dL, Creatinine 6.96 mg/dL, eGFR 8.3 mL/min/1.73 m2, and urine protein 4 +.
Relevant Catheterization Findings
Coronary angiogram showed right dominant system, 53% lesion in proximal right coronary artery (RCA), 30% lesion in mRCA and iFR showed non-significant pressure gradient (iFR spot of 0.97, and iFR pullback of 0.93), normal left main artery and left anterior descending, prominent obtuse marginal 2 artery, small caliber distal LCX, and a chronic total occlusion 100% distal LCX with bridging collaterals.
Interventional Management
Procedural Step
Physiological assessment of the RCA was undertaken. BMW guidewire was inserted to RCA through EBU 3.5-6F. Instant Wave-Free ratio on the stenotic lesion in the proximal RCA was calculated using the Volcano Verrata Plus pressure wire. The Verrata Plus pressure wire was inserted and pressures were equalized at the ostium of the RCA, and advanced distal to the stenotic lesion. The calculated iFR spot measurement was 0.97, indicative of non-significant stenotic lesion, as the cut-off value is 0.89. The calculated iFR pullback assessment technique was done and showed a majority pressure gradient of 0.93, which was also indicative of a non-significant stenotic lesion, therefore the intervention option was ruled out.
Case Summary
Patients with coronary artery disease concomitant with CKD is considered as a high bleeding risk (HBR) population, therefore warrants careful decision making for a coronary revascularization. Instant Wave-Free Ratio (iFR) could be considered as a useful tool to improve the accuracy in decision making for coronary stenting, as it could give clinician a useful information whether a stenotic lesion is flow limiting and portends ischemic potential of a lesion, particularly in a borderline stenotic lesion.