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Published on: June 28, 2019
Limitation of fractional flow reserve in evaluating coronary artery myocardial bridge
Inder M Singh1, Roopa A Subbarao, Saihari Sadanandan
1Vascular Interventions, Krannert Institute of Cardiology, Indiana University, MPC 2, Room D-4078, 1801 North Senate Blvd., Indianapolis, IN 46202-1258, USA.
Insights
Symptomatic myocardial bridges require medical therapy, but stenting may increase restenosis risk. Fractional flow reserve may offer limited value in guiding revascularization for myocardial bridges.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Symptomatic myocardial bridges are typically managed with medical therapy.
- Percutaneous revascularization is considered for refractory cases.
- Myocardial bridges present unique challenges compared to atherosclerotic coronary artery disease.
Observation:
- Two cases illustrate distinct coronary compression and flow patterns in myocardial bridges.
- Myocardial bridges exhibit anatomical and physiological differences from fixed atherosclerotic stenosis.
- These differences impact the evaluation and treatment strategies.
Findings:
- Fractional flow reserve (FFR) may have limited utility in assessing the functional severity of myocardial bridges.
- Stenting, including drug-eluting stents, poses a higher risk of in-stent restenosis in myocardial bridges.
- The dynamic nature of myocardial bridge compression differs from static atherosclerotic lesions.
Implications:
- Revascularization decisions for myocardial bridges require careful consideration beyond standard stenosis assessment.
- Alternative revascularization strategies may be necessary to mitigate restenosis risks.
- Further research is needed to optimize treatment algorithms for symptomatic myocardial bridges.
Abstract:
Symptomatic myocardial bridge is treated with medical therapy, but in refractory cases, percutaneous revascularization has been used. We describe two cases to highlight differences in coronary compression and flow pattern, which make the luminal narrowing associated with a myocardial bridge anatomically and physiologically different from the fixed stenosis of atherosclerotic epicardial disease. Due to these characteristics, evaluating the functional severity of a myocardial bridge using fractional flow reserve as a guide to revascularization may be of limited value. Furthermore, stenting, including drug-eluting stents, may not be the ideal revascularization strategy secondary to a higher risk of in-stent restenosis.