The day's trial evidence turns on selecting non-culprit lesions by function rather than appearance. Many laboratories cannot do this for every case - the wire is not available, the patient is unstable, or the lesion is not amenable. That is a legitimate constraint, and it is not the problem.
The problem is silence. When a staged procedure is planned on angiographic appearance alone, write that in the report explicitly: which lesions were assessed by physiology, which were judged visually, and why. The operator who does the staged case weeks later has no way to know which it was, and a visually assessed 60% stenosis and a functionally significant one look identical in the images.
- State in the report which non-culprit lesions were physiologically assessed and which were not.
- Record the reason when physiology was not obtained: instability, access, availability.
- Flag visually assessed lesions for reassessment at the staged procedure rather than treating them as decided.
- Give the staged operator the diameter stenosis and the vessel, not just 'significant disease'.
- Keep the culprit-lesion result and the non-culprit plan in separate paragraphs so neither is read as the other.
Why it matters
The strategy that works depends on knowing how a lesion was judged, and that information is routinely lost between the index and staged procedures.
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