Some of the noise bites from a busy cath lab after a mid noon angioplasty
Oh’ that looks bad , whats that projecting !
There is some haziness too ,
Make sure its not a flap,
Better to do IVUS or should I OCT ?
Shall I post dilate with NCB ?
Should we cover with another stent ?
I think we can manage with Tirofiban or Reopro
Call the chief ! suggested a first year resident,that seemed to be the most reasonable noise bite among all .Yes, the final command came from the chief cardiologist after a 10 second glance over the workstation ,”Guys, forget it , . . its acceptable pinching, DAPT will take care of it , just ensure adequate ACT till night , put the next case . . .on table” !
That’s fairly common chat session in any high volume cath centres (Which ended abruptly in this case with the chief’s uttering)
Does any body know what the chief meant by the term pinching ?
- Is it the pinch of Intimal fold ?
- Is it pinch of plaque ?
- Is it a flap ?
- Is it a plaque prolapse within the strut ?
- Or just a evaginated thrombus
- A subintimal calcium speck ?
- A longitudinal stent deformation?
Any one knows the histology ? Is there any natural history study of such pinching ?
Iam afraid no one knows . But common sense tell us it can be anything between a totally benign entity to Imminent nidus for an acute stent thrombosis , depending upon the patient’s destiny and physician’s luck !
How does one make a decision in such an uncertain situation ?
The decision to leave that pinching is taken by any cardiologist based on his past experience or Inexperience or both. Some do IVUS/OCT , many don’t . Whatever the decision ( empirical or scientific ) its going to be tentative and outcome is any body’s guess.
Final message
Coronary arterial pinching is a dangerous cath lab slang used exclusively by expert Interventional cardiologists , often after a hurried PCI ! It may sound innocuous .To label a protruding plaque as a “safe pinch”demands heavy courage that is an essential requirement for a successful Interventional cardiologist , which most of them are blessed with !
Reference
1.No Reference as such :There is no specific study about histology of coronary pinching .Though , IVUS and OCT data are available for various post PCI shadows , it never addresses the issue of pinching specifically as no one is clear about what they mean by it. Hence ,we are planning to decode this long pending mystery with our own PINCH-iVUS study.
2.This article from Circulation Imaging new generation IVUS could reveal histology of pinching
Dr.S.Venkatesan MD 