SYNTAX II Trial: Complex PCI Case in a High-Risk Patient

Watch an in-depth case study from the SYNTAX II Trial of a high-risk patient undergoing complex Percutaneous Coronary Intervention (PCI), led by Simon Walsh.

The patient had atrial fibrillation, multiple comorbidities, impaired ventricular function, a high SYNTAX score of 47.5, severe left main disease, and significant circumflex calcification, creating substantial procedural challenges.

Given the patient’s elevated surgical risk, the heart team chose PCI over bypass surgery and employed advanced strategies to achieve full revascularization while minimizing contrast use to protect renal function.

This case study demonstrates the integration of careful planning, advanced techniques, and innovative tools in the management of complex coronary artery disease. Through discussions, they highlight how meticulous strategies can minimize complications and achieve full revascularization, improving long-term patient outcomes even in high-risk scenarios.

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Chapters:
0:11 - Patient background and clinical context
1:07 - Syntax score and treatment decision by the heart team
2:28 - Pros and cons of PCI for the case
5:16 - Decision-making using IFR and FFR
6:08 - Staged procedures and strategies for CTO
8:30 - Crossing the lesion with advanced guide wires
9:30 - Stenting and optimization with imaging
11:00 - Rotational atherectomy and calcium modification
14:03 - Final steps of stent implantation and optimization
16:12 - Procedure results: Imaging and functional outcomes
18:26 - Residual Syntax score and long-term patient management
19:52 - Key insights on PCI standards and outcomes