TCTAP C-146 "Coronary Artery Longitudinal Distortion" in Very Tortuous RCA Percutaneous Coronary Intervention

Clinical Information Patient Initials or Identifier Number H.R.Relevant Clinical History and Physical Exam A 70 years old woman No underlying disease Presented with chest tightness and progressive dyspnea for 3 days Physical examination at general hospital revealed fine crepitation both lungs, EKG showed LBBB and troponin T positive (123 serial up to 156 ng/l). LVEF = 37% with global hypokinesia, functional moderate to severe MR. No pericardial effusion.Relevant Catheterization Findings CAG showed 80% stenosis with heavy calcification at mid LAD. Tortuous RCA with 90% stenosis at mid RCA What is your plan management? A) CABG with MV repair B) FFR both lesions C) PCI to RCA first D) PCI to LAD first E) PCI both RCA and LADInterventional Management Procedural Step My strategy 1) The patient and relatives refused to do surgery 2) I did not do FFR because FFR was unreliable in NSTEMI setting (FUTURE trial) and very tortuous RCA 3) I planned to do PCI at RCA first because it looked more simple (LAD might need rotational atherectomy) - PCI at RCA: