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Fractional flow reserve versus angiography in left circumflex ostial intervention after left main crossover stenting
Chang-Wook Nam1, Seung-Ho Hur, Bon-Kwon Koo
1Department of Internal Medicine, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, Korea.
Insights
Angiographic stenosis and fractional flow reserve (FFR) often disagree in jailed left circumflex artery (LCX) lesions after left main (LM) crossover stenting. Many lesions deemed significant by angiography were not functionally significant by FFR.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Physiology
Background:
- Discrepancies exist between angiographic stenosis and functional significance in non-left main bifurcation lesions.
- Left main (LM) to left anterior descending artery (LAD) crossover stenting can result in jailed ostial left circumflex artery (LCX) lesions.
Purpose of the Study:
- To compare angiographic stenosis severity with fractional flow reserve (FFR) in jailed ostial LCX lesions post-LM-to-LAD crossover stenting.
- To evaluate the functional significance of jailed LCX lesions.
Main Methods:
- Twenty-nine patients undergoing LM-to-LAD crossover stenting were enrolled.
- Fractional flow reserve (FFR) was measured in jailed ostial LCX lesions after stenting.
- Additional intervention was performed for lesions with FFR <0.8.
Main Results:
- Mean LCX diameter stenosis post-stenting was 56±21%.
- 59% of jailed LCX lesions showed angiographically significant stenosis (>50%).
- Only 29% of these angiographically significant lesions were functionally significant (FFR <0.8) and required further intervention.
Conclusions:
- A significant discrepancy exists between angiographic stenosis and FFR in jailed LCX lesions after LM crossover stenting.
- Angiography alone may overestimate stenosis severity in these specific lesions.
Background And Objectives:
Discrepancy between angiographic percent (%) diameter stenosis and fractional flow reserve (FFR) exists in non-left main bifurcation lesions. The aim of this study was to compare angiographic stenosis severity and FFR in jailed ostial left circumflex artery (LCX) lesions after left main (LM)-to-left anterior descending artery (LAD) crossover stenting.
Subjects And Methods:
Twenty-nine (n=29) patients with distal LM or ostial LAD lesions treated by LM-to-LAD crossover stenting were consecutively enrolled. After successful stenting, FFR was measured at the jailed LCX. Additional intervention was performed in lesions with FFR <0.8.
Results:
The mean reference diameter of LCX was 3.1±0.4 mm, and percent diameter stenosis after crossover stenting was 56±21%. Angiographically significant stenosis (>50%) at the ostial LCX occurred in 59% (17/29) of cases. Among them, only five (29%) lesions had functional significance, and underwent additional procedure. During follow-up, three patients in the deferral group and two patients in the additional intervention group had target lesion revascularization.
Conclusion:
There was a discrepancy between angiographic percent diameter stenosis and FFR in jailed LCX lesions after LM crossover stenting.
