SCAI 2026 Seeing Better, Treating Better: Advancing Patient Outcomes Through Advanced Coronary Imaging-Live Case from the Hospital Clinico San Carlos, Madrid, Spain, Drs. Escaned and Gonzalo

Live Case from the Hospital Clinico San Carlos, Madrid, Spain, Drs. Escaned and Gonzalo

Video Transcription

Video Summary

A 62-year-old woman with cardiovascular risk factors presented with an inferior STEMI and multivessel coronary disease. Her RCA had already been treated during primary PCI, and this live case focused on the non-culprit LAD lesion. The team used a combination of physiology (FFR and iFR), intravascular ultrasound (IVUS), and angiography co-registration with Philips’ Intrasight Plus system to assess the LAD in detail.<br /><br />Although angiography suggested moderate disease, physiology showed the lesion was functionally significant, with an FFR of 0.70 and a positive iFR pullback demonstrating diffuse disease from the proximal to mid LAD extending to the ostium. IVUS revealed substantial plaque burden, calcification, and a very proximal ostial LAD lesion near the left main and diagonal bifurcation. Based on this integrated assessment, the operators decided that both the proximal and mid LAD segments required treatment, necessitating crossover stenting into the left main.<br /><br />They performed pre-dilation with non-compliant balloons and implanted a stent, using dynamic road mapping, device detection, and live IVUS/physiology co-registration to optimize positioning and length selection. Final imaging and physiology showed a much improved result. The discussion emphasized how imaging and physiology complement each other, improve precision, and may help drive broader adoption of these tools in cath labs.

Asset Caption

closed captions are computer-generated

Keywords

inferior STEMI

multivessel coronary disease

LAD lesion

FFR and iFR

IVUS

left main crossover stenting

angiography co-registration