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Quantitative flow ratio of the donor coronary artery supplying a chronic total occlusion territory
Karim Elbasha1,2, Sultan Alotaibi3,4, Mohamed Samy3,5
1Cardiology Department, Heart Center Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany. drkarim.elbasha@gmail.com.
Insights
Quantitative flow ratio (QFR) can assess intermediate coronary lesions in donor arteries supplying chronic total occlusions (CTOs). QFR may overestimate lesion severity, impacting treatment decisions for CTO interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary physiology guidance improves outcomes in multi-vessel coronary intervention.
- Hemodynamic assessment of intermediate lesions in donor arteries supplying CTOs presents challenges.
- Quantitative flow ratio (QFR) offers a potential solution for evaluating these lesions.
Purpose of the Study:
- To evaluate the implementation of QFR for assessing angiographically intermediate lesions.
- Focus on the main donor coronary artery supplying a chronic total occlusion (CTO) territory.
- Assess QFR's accuracy before and after successful CTO percutaneous coronary intervention (PCI).
Main Methods:
- 219 patients with single main donor vessel to CTO territory recruited.
- Offline QFR analysis performed on intermediate lesions of donor vessels.
- Evaluation conducted before and 6 months after successful CTO PCI.
Main Results:
- Mean QFR in donor vessels significantly increased post-CTO revascularization (0.93 to 0.95).
- This increase was more pronounced in vessels with intermediate stenosis (0.88 to 0.92).
- QFR showed no significant change in angiographically normal donor vessels (0.97).
Conclusions:
- QFR overestimates the severity of intermediate coronary lesions in donor vessels supplying CTO territories.
- Findings are consistent with other invasive modalities for physiological assessment.
- QFR's overestimation may influence treatment decisions in CTO interventions.
Background:
Coronary physiology to guide multi-vessel coronary intervention is associated with better outcome. In the presence of a coronary chronic total occlusion (CTO), hemodynamic evaluation of intermediate lesions in the donor coronary artery supplying a CTO territory still has limitations. We aim to evaluate implementing quantitative flow ratio (QFR) in assessing angiographically intermediate lesions of the main donor coronary artery supplying a CTO territory.
Methods:
We recruited 219 patients with a single main donor vessel to a CTO territory from a single-center CTO registry between 2017 and 2020. Angiographically intermediate coronary lesions of the donor vessels were evaluated using offline QFR before and at a median of 6 months after successful percutaneous coronary intervention (PCI) of CTO.
Results:
The mean age of the study population was 66.9 ± 11.3 years, and 77.6% were males. Three-vessel disease was documented in 49.8%. The mean QFR value increased significantly in the donor vessels after successful CTO revascularization (0.93 ± 0.062 vs. 0.95 ± 0.046, p < 0.001) and was more prominent in donor vessels with angiographically intermediate stenosis (0.88 ± 0.063 vs. 0.92 ± 0.053, p < 0.001). While the change in QFR was not significant in angiographically normal donor vessel (0.97 ± 0.025 vs. 0.97 ± 0.026, p = 0.814). Fifteen patients had hemodynamically significant stenosis in the donor coronary artery (QFR ≤ 0.80) before CTO-PCI. Among those patients, 40% (n = 6) were turned to be non-significant with QFR > 0.80 after CTO recanalization, and 30% (n = 5) patients remained significant and were treated with PCI.
Conclusion:
QFR overestimates the severity of intermediate coronary lesions of a donor vessel supplying a CTO territory like other invasive modalities for physiology assessment.
