The role of fractional flow reserve to guide stent implantation
F Mangiacapra1, L Di Serafino, E Barbato
1Cardiovascular Center, OLV Hospital, Aalst, Belgium.
Insights
Fractional flow reserve (FFR) improves coronary artery disease (CAD) treatment by assessing lesion significance. FFR-guided strategies are safer and more effective than angiography alone for revascularization decisions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Many patients with suspected coronary artery disease (CAD) undergo coronary angiography without functional evaluation.
- Angiography alone has limitations in assessing the functional significance of coronary lesions.
Purpose of the Study:
- To highlight the role of Fractional Flow Reserve (FFR) in guiding revascularization decisions for CAD.
- To emphasize the benefits of FFR over traditional angiography-guided approaches.
Main Methods:
- FFR measurement using pressure wires to assess hemodynamic significance of coronary stenoses.
- Evaluation of hyperemic pressure gradients across coronary lesions.
Main Results:
- FFR provides crucial functional information beyond anatomical assessment.
- FFR-guided treatment strategies demonstrate equal safety and superior efficacy compared to angiography-guided Percutaneous Coronary Intervention (PCI).
Conclusions:
- FFR is a valuable tool for interventional cardiologists to integrate anatomical and functional data.
- FFR enables optimal revascularization strategy selection in patients with CAD, improving outcomes.
Abstract:
In routine clinical practice, a sizeable proportion of patients with suspected coronary artery disease (CAD) undergo coronary angiography without prior non-invasive functional evaluation. In this situation, the decision wheter to perform revascularization is taken solely on the basis of angiographic parameters, which are often limited in assessing the lesions that are functionally significant and ultimately responsible for patients' symptoms. Fractional flow reserve (FFR) is a validated method for assessing hemodynamic significance of coronary stenoses based on the use of pressure wires and assessment of hyperemic pressure gradients across coronary lesions. FFR can guide clinical decision making in several anatomical settings: e.g. intermediate stenosis, left main stenoses, multivessel disease, bifurcation lesions. Treatment strategies guided by FFR have been shown to be equally safe and more efficacious than angiography-guided PCI. FFR is readily available in the catheterization laboratory, and can be easily measured during coronary angiography. FFR represents a unique tool for interventional cardiologists to combine anatomical and functional information, allowing the selection of optimal revascularization strategy in patients with CAD.
