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IVUS-guided PCI Optimisation — EECC MCQ

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HardCoronary Artery DiseaseIVUS-guided PCI OptimisationEECC

A 58-year-old man undergoes PCI to a mid-LAD lesion during NSTEMI. Intravascular ultrasound (IVUS) is performed after stent deployment. Which of the following IVUS findings would most warrant further optimisation with post-dilation?

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Correct answer: B — Minimum stent area of 4.0 mm² with significant residual plaque burden at the proximal stent edge

Intravascular imaging-guided PCI optimisation criteria from the ULTIMATE and ILUMIEN IV trials indicate that a minimum stent area <5.0 mm² in a proximal or mid-LAD vessel is suboptimal and warrants post-dilation to achieve adequate expansion. A minimum stent area of 4.0 mm² with significant residual plaque burden at the stent edge is associated with increased risk of stent thrombosis and restenosis. Minor edge dissections (<1 mm) and mild tissue protrusion are generally benign findings that do not require intervention. The 2024 ESC CCS Guidelines recommend intravascular imaging to guide complex PCI (Class IIa).

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes