Basic instincts in cath lab : It is too tempting to poke the non IRA . . . What shall I do ?

Doing multivessel PCI during acute STEMI is forbidden except in cardiogenic  shock . (or in some very unstable patients without cardiogenic shock) The reason During acute MI   hemodynamics  are precariously balanced.We do not know yet how  emergency multivessel plasty alters this . Our  initial aim should be   confined to myocardial salvage in the IRA . Total myocardial revascularization is niether  the  priority nor its desirable. The more  time  you spend  within the inflamed coronary artery , more its  hazardous. Multiple stenting  is prone for thrombus   and  migration  into side branch . Stent opposition is sub optimal in many thrombus infested lesions.   Still  . . .  in real world it is extremely difficult to curtail the urge to stent  all eligible lesion during primary PCI !     How to avoid it ?  If the patient is poor or the insurance limit is low , the issue  of multi vessel stenting does not arise at all  ! Always  ignore  complex  non IRA lesions  during primary  PCI. Be happy if a non IRA has a bifurcation lesion ! Still , some lovely looking lesions in non IRA  would be  tempting  and inviting .  Indulge at your own risk ! * Please remember if  the proximal  LAD  has a non IRA lesion , it may be sensible to attempt  simultaneous revascularisation even if the patient is stable ! Other unrealistic advice Keep the professional fee and other benefits   fixed whether  we do a single or multiple   vessel ste...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiology -Interventional -PCI cath lab tips and tricks ira vs nonira angioplasty multivessel angioplasty in stemi primary pci Source Type: blogs