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Guiding catheter engagement can artificially lower fractional flow reserve (FFR) measurements, potentially altering treatment decisions for coronary stenosis. Disengaging the catheter often improves FFR values, especially for proximal lesions near the cutoff.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Fractional flow reserve (FFR) measurements can be affected by guiding catheter (GC) placement in the coronary ostium.
  • Artificial ostial stenosis from GC engagement may impede hyperemic flow, impacting FFR accuracy.

Purpose of the Study:

  • To investigate if selective GC engagement affects hyperemic flow and FFR measurements.
  • To determine the impact of GC disengagement on clinical decision-making for coronary stenosis.

Main Methods:

  • Prospective measurement of FFR with GC engaged (FFReng) and disengaged (FFRdis) in 202 intermediate coronary stenoses.
  • Assessed the significance of ΔFFReng-FFRdis compared to test-retest repeatability.
  • Analyzed the clinical significance and impact on treatment strategy and stenosis location.

Main Results:

  • FFR significantly changed after GC disengagement (FFReng 0.84±0.08 vs. FFRdis 0.80±0.09, P<0.001).
  • In 19% of cases with FFReng 0.81-0.85, disengagement shifted the FFR below the 0.80 cutoff, changing treatment from medical therapy to PCI.
  • GC disengagement impact was more pronounced in proximal/middle segments (0.04±0.03) than distal segments (0.03±0.03, P=0.042).

Conclusions:

  • Guiding catheter disengagement shifts FFR values across the 0.80 clinical cutoff in 19% of measurements.
  • This shift predominantly occurs in proximal/middle coronary segments with FFR values near the cutoff.
  • Accurate FFR assessment may require consideration of GC influence, particularly in specific anatomical locations and FFR ranges.