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Posts Tagged ‘stenting in non flow limiting lesion’

Modern  day cardiac scientists have legally defined a significant coronary  lesion as > 70 % obstruction. Unfortunately this rule is applicable more in  academic forums not in cath labs.

While the guidelines seem to be clear in chronic coronary syndromes , in ACS  the interventional strategies based on  severity of lesion is  not  clearly defined.

Many times  in a  recannalised coronary artery following STEMI  (Either  spontaneous  or pharmacological )  even a 10-20  % lesion is stented .(Mind you ,  coronary erosion  that  trigger  pure thrombotic  STEMI  will be stented by most  of the  proud  young cardiologists of today !) The guidelines conveniently  ignore this area  allowing  the cardiac physicians  to  indulge in the coronary exotica !

Is this logical ?

Why do you need to stent a successfully lysed coronary  lesion with TIMI 3 flow. ?(We do know , many  young infarcts have pure thrombotic STEMI with zero % lesion   (In India 40% of young STEMI has near normal CAG  )

This situation arises by an ill conceived concept called pharmaco- invasive approach where routine coronary angiogram is advocated even after successful thrombolysis  in patient  who is asymptomatic and complete salvage of myocardium has been achieved  by pharmacological means .

* The only way to prevent this excess  is to ban the  pharmaco -Invasive approach for  asymptomatic and apparently successful thrombolysis .(Better still  even CAG should be banned ! for  the  simple reason an inappropriate CAG  begets an Inappropriate PCI !)

A Narrow  gap  separates  Ignorance and  knowledge !

Does the  PCI  makes the  ill-fated site  less vulnerable   for future events  . . .  when compared to   well  re-cannlised native coronary artery with negligible lesion ?

The funny side of  cardiac science  can be appreciated , when  somebody  is implanting a latest generation stent for 10-20 % lesion  just because it is associated with an ACS ,  another would astutely   study  the significance of 70-80% lesion  by FFR  in  an adjacent lab !

 

 

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