One of the hottest debate in the recent world cardiology forum in Barcelona WSC 2014 , was about how to tackle incidentally detected non IRA lesions during primary PCI.
So far , the dictum is , one should not meddle the non culprit lesions unless demanded by hemodynamic instabilty .The next option is to do a staged PCI for these lesions. (Few days later). or just forget about these lesions unless they are critical.
Now new studies are appearing that suggest doing all “do-able” lesions must be stented in one go ! This is obviously inviting trouble .The worry is not in the concept but with the dubious track record , fragile guidelines and potential ethical debacle of the cardiology community !
Stent “As you want and as you please” has already invaded our mindset in the chronic coronary scenario. Now in 2014 , we want more freedom in acute coronary syndrome as well ! We can’t ask for a referee less game of soccer !
We clearly know coronary arteries are to be respected and do not deserve indiscriminate stenting especially in ACS where the early hazard is more.
A recent story which I heard was a height of futility . A semi experienced cardiologist in the suburbs of a big southern Indian city , opened successfully a LAD which was the IRA and subsequently caused acute LCX STEMI , while trying to tackle an insignificant non culprit lesion due to procedural mishap ! (Some suggested migration of LAD thrombus !)
What a pity , when we are supposed to arrest the culprit, in reality it is simply chased down to another territory !
Here comes unique advantage of thrombolysis , you need not locate the culprit artery the drug chases it wherever it is , even if they are multiple ! Read in this link :
We call it as fate when thrombus suddenly occlude a coronary artery and the IRA becomes a culprit . We need not compete with fate and end up creating potential new culprits.Let the sixth sense prevail over the five .Use judicious discretion when trying to stent muti-vessel CAD during PCI. Please realise ,the concept of multivessel stenting during pPCI is not wrong . How we interpret is the issue !
There is no excuse to indulge as you like , simply because your intentions are good !