Effect of guidewire insertion in fractional flow reserve procedure for real geometry using computational fluid...

Area of Science:

• Cardiovascular physiology
• Medical imaging
• Computational fluid dynamics

Background:

• Coronary artery disease (CAD) impairs blood flow to the heart, necessitating accurate stenosis severity assessment for treatment.
• Fractional flow reserve (FFR) is a key diagnostic tool, but guidewire insertion may introduce measurement errors.
• Understanding these errors is crucial for effective clinical decision-making in CAD management.

Purpose of the Study:

• To quantify the impact of guidewire insertion on FFR measurements in coronary arteries.
• To evaluate the accuracy of FFR compared to actual flow ratios under simulated conditions.
• To analyze the influence of guidewire on pressure drop and distal dynamic pressure (CDP).

Main Methods:

• Utilized patient-specific 3D coronary artery geometry from scans.
• Developed a 3D computational fluid dynamics model simulating non-Newtonian, pulsatile blood flow.
• Numerically simulated blood flow with realistic boundary conditions, comparing FFR with and without a guidewire.

Main Results:

• Guidewire insertion significantly overestimated stenosis severity in moderate cases, reducing FFR from 0.43 to 0.33 (23.26% error).
• The ratio between pressure drop and distal dynamic pressure (CDP) increased by 35.6% (from 5.31 to 7.2) due to guidewire presence.
• Mild stenosis FFR values showed minimal change (0.83 to 0.82), indicating less impact in less severe cases.

Conclusions:

• Guidewire use can lead to significant overestimation of coronary artery stenosis severity, particularly in moderate cases.
• Physicians must account for guidewire-induced FFR errors when determining patient treatment strategies.
• Accurate assessment of stenosis is vital for appropriate management of coronary artery disease.