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How to prevent unnecessary coronary interventions: identifying lesions responsible for ischemia in the cath lab
1Department of Internal Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock 72205-7199, USA. audeyamilw@uams.edu
Insights
Fractional flow reserve (FFR) measurement is the optimal method for evaluating intermediate coronary lesions that may cause ischemia. This review compares FFR, coronary flow reserve (CFR), and intravascular ultrasound (IVUS) techniques.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Coronary angiography cannot reliably identify intermediate coronary lesions causing ischemia.
- Accurate assessment of intermediate coronary stenoses is crucial for guiding revascularization decisions.
Purpose of the Study:
- To review and compare three techniques for evaluating the physiologic significance of intermediate coronary stenoses: fractional flow reserve (FFR), coronary flow reserve (CFR), and intravascular ultrasound (IVUS).
Main Methods:
- Discussion of pressure wire-derived FFR measurements.
- Explanation of Doppler wire-derived CFR measurements.
- Overview of intravascular ultrasound (IVUS) imaging.
Main Results:
- All reviewed techniques (FFR, CFR, IVUS) are validated for assessing functional significance of intermediate stenoses.
- Each technique possesses inherent limitations that must be considered.
- FFR measurement is identified as the superior method for interrogating intermediate coronary lesions.
Conclusions:
- Fractional flow reserve (FFR) measurement is the preferred method for assessing the functional significance of intermediate coronary lesions.
- Understanding the strengths and limitations of FFR, CFR, and IVUS is essential for clinical decision-making.
- This review provides a comparative analysis to aid in the selection of the most appropriate technique.
Purpose Of Review:
Coronary angiography is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In the catheterization laboratory three techniques can be used for the evaluation of the physiologic significance of intermediate or borderline significant coronary stenoses: (1) pressure wire-derived coronary fractional flow reserve (FFR), (2) Doppler wire-derived measurement of coronary flow reserve (CFR), and (3) intravascular ultrasound (IVUS).
Recent Findings:
All of these techniques have been validated for assessing the functional significance of intermediate stenoses, but also have inherent limitations.
Summary:
Overall, measurement of FFR appears to be the best method for interrogating intermediate coronary lesions. This review discusses the strengths and limitations of each of these techniques.