Incidental finding of PET-avid lesion at base of tongue, thought likely to be cancer. PET scan arranged due to incidental finding of RLL lesion during CTPA (RLL lesion not PET-avid, non-concerning)
- IHD – recent angina (not ACS), 90% LAD lesion 2 x stents placed 2/7 ago. Surgery planned in 1wk. Symptoms now resolved.
- Ex-heavy smoker
- ? OSA – high STOPBANG but low ESS
- High BMI
- Ex-tol > 4 METS
- Surgery timing
- Usually the minimum time frame between PCI and surgery is 1/12 (based on most recent evidence J Am Coll Cardiol 2016;68:2622–32) however even this cardiologist dependent. Other relevant factors – stent location, number, caliber, overlaps, branching.
- See attached article
- Discussions documented between surgical and cardiology teams suggest that everyone is in agreement with a plan for surgery and cessation of DAPT for 7d prior.
- Patient at high risk of stent thrombosis if surgery proceeds now.
- Availability of emergency PCI on site is ideal, however being an LAD lesion, stent thrombosis may be fatal due to large myocardial territory at risk.
- could aspirin be continued at the minimum?
- Would TTE be beneficial?
- Reassuring exercise tolerance and absence of any symptoms.
- Long term LAD ischaemia can lead to significant LV dysfx.
- Low risk/stress surgical procedure
- For discussion with surgical and cardiology teams to ensure that there has been no miscommunication about the timeline and to query if aspirin, at least, could be continued.
- For TTE if time allows but wouldn’t delay surgery to obtain.
- Update: Cardiologist contacted – unaware that the procedural cardiologist had stented the vessel (rather than just angiography) and so yes, surgery will need to be delayed for 1/12 of DAPT.