Al Nooryani A, Aboushokka W, Beleslin B, Nedeljkovic-Beleslin B. Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data: A case report. World J Clin Cases 2024; 12(13): 2269-2274 [PMID: 38808347 DOI: 10.12998/wjcc.v12.i13.2269]
Corresponding Author of This Article
Branko Beleslin, FACC, FESC, MD, PhD, Full Professor, Department of Cardiology, Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade 11000, Serbia. branko.beleslin@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2024; 12(13): 2269-2274 Published online May 6, 2024. doi: 10.12998/wjcc.v12.i13.2269
Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data: A case report
Arif Al Nooryani, Wael Aboushokka, Branko Beleslin, Biljana Nedeljkovic-Beleslin
Arif Al Nooryani, Wael Aboushokka, Department of Cardiology, Al Qassimi Hospital, Sharjah 1234, United Arab Emirates
Branko Beleslin, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade 11000, Serbia
Biljana Nedeljkovic-Beleslin, Institute of Endocrinology, Diabetes and Metabolic Disorders, Univeristy Clinical Center of Serbia, Belgrade 11000, Serbia
Biljana Nedeljkovic-Beleslin, Department of Internal Medicine/Endocrinology, Medical faculty, University of Belgrade, Belgrade 11000, Serbia
Author contributions: Al Nooryani A contributed to conception, design, acquisition of data and final approval; Aboushokka W contributed to acquisition of data, analysis and interpretation; Beleslin B contributed to conception, design, acquisition of data, analysis, writing the case report; Nedeljkovic-Beleslin B contributed to analysis, interpretation and critical analysis.
Informed consent statement: Study participant provided informed written consent prior to diagnostic intervention.
Conflict-of-interest statement: All authors declare that they don’t have conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Branko Beleslin, FACC, FESC, MD, PhD, Full Professor, Department of Cardiology, Medical Faculty, University of Belgrade, Dr Subotica 8, Belgrade 11000, Serbia. branko.beleslin@gmail.com
Received: December 22, 2023 Peer-review started: December 22, 2023 First decision: January 10, 2024 Revised: January 25, 2024 Accepted: March 20, 2024 Article in press: March 20, 2024 Published online: May 6, 2024 Processing time: 124 Days and 21.7 Hours
Abstract
BACKGROUND
Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.
CASE SUMMARY
We present a case of 55-year-old male diabetic patient who was admitted for chest pain. Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent. Patient undergone invasive functional testing of intermediate lesion with preserved FFR (0.88), low coronary flow reserve (1.2) and very high index of microvascular resistance (84). Due to discrepancy in invasive functional parameters, intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma. Because of the preserved FFR and no signs of vulnerable plaque, the interventional procedure was deferred and the patient continued with optimal medications.
CONCLUSION
Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.
Core Tip: We present a case of the diabetic patient with moderate-to-severe coronary stenosis with preserved fractional flow reserve, low coronary flow reserve, high index of microvascular resistance and intravascular optical coherence tomography image demonstrating fibrotic plaque without signs of thin-cup fibroatheroma. Combined functional and anatomic imaging of intermediate coronary stenosis represent comprehensive contemporary decision pathway in the management of the patients.
