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: drsvenkatesan Tags: Cardiology -Interventional -PCI cath lab tips and tricks ira vs nonira angioplasty multivessel angioplasty in stemi primary pci Source Type: blogs
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