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Updated: Jan 28, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Physiology-Guided Management of Serial/Diffuse Coronary Artery Disease
Christopher S G Murray1, Tariq Siddiqui2, Norma Keller3
1Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, NY, USA. cmurrayrph@gmail.com.
Physiological assessment of coronary artery disease (CAD) lesions has evolved beyond angiography, improving intervention decisions. Current techniques are effective, though consensus on best practices for serial stenoses is still developing.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Coronary artery disease (CAD) management advanced with angioplasty and stenting over 40 years ago.
- Early focus was on angiography and lesion diameter stenosis.
- Dr. Andreas Gruentzig pioneered minimally invasive treatments in 1977.
Purpose of the Study:
- Review physiologic advancements in CAD management over the past 20 years.
- Discuss the current state and future prospects of physiological assessment.
- Highlight the shift from anatomical to physiological evaluation of coronary lesions.
Main Methods:
- Review of progress in physiological assessment techniques for coronary lesions.
- Analysis of the shift in decision-making from angiography to physiological significance.
- Evaluation of studies comparing different physiological assessment methods.
Main Results:
- Emphasis shifted to physiological significance over anatomical stenosis for intervention decisions.
- Physiological assessments better discriminate flow-limiting lesions.
- Currently available techniques are non-inferior and highly effective.
Conclusions:
- Consensus on best practices for physiological assessment of serial stenoses is still needed.
- Physiological assessment significantly improves decisions for coronary artery interventions.
- The field has progressed significantly, with effective tools available.
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