Physiology-Based Revascularization: A New Approach to Plan and Optimize Percutaneous Coronary Intervention

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Diagnostic Imaging

Background:

• Fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPR) are standard for coronary atherosclerotic disease.
• Current evidence primarily supports pre-interventional physiological assessment for revascularization decisions.
• The role of post-interventional physiological assessment remains less established but shows promise.

Purpose of the Study:

• To review the evolving role of physiological assessment in coronary revascularization.
• To highlight the importance of post-interventional assessment for optimizing results and prognosis.
• To discuss the utility of pullback tracings for characterizing coronary atherosclerotic disease patterns.

Main Methods:

• Comprehensive review of current scientific evidence on coronary physiological assessment.
• Analysis of data regarding pre- and post-interventional physiological assessment applications.
• Exploration of pullback tracings and post-processing methods for disease characterization.

Main Results:

• Post-interventional physiological assessment can optimize immediate revascularization and long-term prognosis.
• Pre-interventional pullback tracings can characterize focal vs. diffuse disease and stenosis severity.
• Disease characterization via pullback tracings helps predict post-interventional physiological outcomes.

Conclusions:

• Physiological assessment is evolving into a functional optimization tool for the entire revascularization process.
• Further understanding and integration of post-interventional assessment into daily practice are crucial.
• Pre-interventional pullback analysis offers valuable insights for targeted revascularization strategies.