Clinical applications of fractional flow reserve in bifurcation lesions
1Seoul National University College of Medicine, 101 Daehang-ro, Chongno-gu, Seoul 110-744, South Korea.
Insights
Fractional flow reserve (FFR) guides percutaneous coronary intervention (PCI) for complex bifurcation lesions, improving outcomes. Understanding FFR is crucial for successful PCI in these challenging cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Coronary Artery Disease
Background:
- Percutaneous coronary intervention (PCI) for coronary bifurcation lesions has lower success rates and worse outcomes than for simple lesions.
- Angiographic assessment alone may not accurately reflect the functional significance of bifurcation lesions.
Purpose of the Study:
- To evaluate the role of fractional flow reserve (FFR) in guiding PCI for coronary bifurcation lesions.
- To highlight the importance of understanding coronary physiology and FFR for complex PCI procedures.
Main Methods:
- Utilizing fractional flow reserve (FFR) as a physiologic parameter to assess stenosis severity and myocardial territory.
- Employing an FFR-guided provisional side branch intervention strategy for bifurcation lesions.
Main Results:
- FFR-guided strategy for bifurcation lesions is feasible and effective.
- This approach can reduce complex interventions and associated complications.
Conclusions:
- FFR is a reliable parameter for guiding PCI in coronary bifurcation lesions.
- Adequate understanding of coronary physiology and FFR is essential for optimal PCI outcomes in complex cases.
Abstract:
Percutaneous coronary intervention (PCI) for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the functional significance of bifurcation lesions. The fractional flow reserve (FFR) is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.
