Optimising PCI by Intracoronary Image-guidance.

Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled trials demonstrating a benefit in acute procedural and clinical outcomes. ICI provides an opportunity to guide PCI, detailing the nature of the coronary disease, potentially influencing lesion preparation and stent selection. Following stent deployment, ICI offers a detailed assessment of lesion coverage, associated vessel trauma and stent expansion. Consensus statements have emphasized the role of ICI and detailed the parameters of stent optimization. However, intracoronary imaging is not adopted widely yet. Significant global differences in the uptake of ICI have been reported, with the vast majority of PCI being angiographically-guided. The three major barriers to the implementation of ICI include, in order of impact, prohibitive cost, prolongation of procedure time and local regulatory issues for use. However, it is our belief that a lack of education and the associated challenges of ICI interpretation provide the greatest barrier to adoption. We hope that this review of the role of ICI in PCI optimization will provide a platform for PCI operators to gain confidence in the utilization of ICI to enhance outcomes for their patients.

Large floating thrombus in the inferior vena cava.

A 32-year-old female presented to the emergency room with severe right loin pain. Abdominal color Doppler ultrasound (CDUS) observed a large thrombus in the inferior vena cava (IVC). Computed tomography with contrast described a large floating thrombus in the IVC with no visible wall attachment. Emergency transjugular suprarenal IVC filter was inserted and overnight infusion thrombolysis over 24 h. The patient started to show constitutional symptoms of pyelonephritis such as high-grade fever and pyuria post-thrombolysis. Immediate empiric antibiotic coverage was started. Overnight infusion thrombolysis resulted in resolution of the floating thrombus and the IVC filter was removed in the next day. Urine culture grew Escherichia coli and tailored antibiotic therapy was completed. Three months CDUS confirmed complete resolution of the IVC thrombosis.