Case 139: PCI Manual - IVUS for culprit vessel identification in NSTEMI

A patient presented with NSTEMI. Coronary angiography showed patent LAD, circumflex and RCA with a vessel filling late in the lateral wall of the heart. Despite performing multiple projections we could not identify the origin of the occluded vessel. We did IVUS of the LAD that demonstrated a flush ostial occlusion of a proximal diagonal. The vessel was wired with a Sion black wire, as confirmed by IVUS. After predilation and stenting antegrade flow was restored in the diagonal.