Comparison of fractional flow reserve and instantaneous wave-free ratio for the hemodynamic assessment of jailed side branches in bifurcation stenting

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.M Altstidl ◽  
M Marwan ◽  
M Troebs ◽  
S Achenbach ◽  
L Gaede
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Balloon Angioplasty ◽  
Functional Significance ◽  
Side Branch ◽  
Fractional Flow ◽  
High Reproducibility ◽  
Flow Reserve ◽  
Hemodynamic Assessment ◽  
The Right

Abstract Background Provisional side-branch stenting strategy is one of the preferred strategies for treatment of bifurcation lesions. Whereas using fraction flow reserve (FFR) for the physiologic assessment of jailed side branches is well studied, the reliability of resting indices such as instantaneous wave free ratio (iFR) is unknown. Methods Consecutive patients with provisional stenting of a bifurcation and a jailed side branch were enrolled in this study. FFR and iFR were measured and, after assuring absence of baseline shift and drift, both measurements were repeated after 3 minutes. Hyperemia was induced by intra-coronary adenosine with a dose of 48μg for the right coronary artery and 96μg for the left coronary artery. Cut-off for the assumed functional significance of a stenosis was 0.80 for FFR and 0.89 for iFR. The decision to treat the side branch was left to the interventionalist's discretion. Results 37 jailed side branches in 36 patients (age 68.4±8.2; male 81% (n=29)) were consecutively enrolled in the study. The main vessel was the left main in 3% (n=1), the left anterior descending (LAD) in 65% (n=24), the diagonal branch (D1) in 3% (n=1), the left circumflex artery (LCX) in 24% (n=9) and the right coronary artery (RCA) in 5% (n=2). The Medina classification revealed true bifurcation stenosis defined as Medina 1–1-1 prior to treatment in 35% (n=13). FFR showed 35% (n=13) of the stenosis to be functionally significant with a high reproducibility of the results (r=0.986). FFR showed a low correlation with angiographic assessment (r=−0.477). iFR indicated hemodynamic relevance in 38% of lesions (n=14) with a high reproducibility (r=0.967) and also correlated poorly with angiographic assessment (r=−0.271). iFR was found to closely correlate with FFR in jailed side branches (r=0.720, Figure 1A). Bland-Altman analysis showed iFR and FFR agreed with a mean difference between FFR and iFR of −0.054±0.146. In 81% (n=30) FFR and iFR showed the same results regarding functional significance. In 8% (n=3) FFR was ≤0.80 and iFR >0.89, in 11% (n=4) FFR was >0.80 and iFR was ≤0.89 (Figure 1B). Side branch treatment was performed in 32% (n=12). All of these lesions showed functional significance in FFR or iFR. Stent implantation was performed in 8% (n=3), balloon angioplasty in 19% (n=7) and balloon angioplasty with a drug-eluting balloon in 5% (n=2). Conclusions The results of this study confirm the poor correlation of angiographic and functional assessment of coronary artery stenoses. Our data show close agreement of iFR and FFR in stent-jailed side branches. Therefore, iFR can be considered as a reliable technique for guidance of provisional side branch stenting. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Malignant Arrhythmia in Acute Conus Artery Occlusion

2021 ◽  
pp. 1-4
Author(s):  
Lucian Calmac ◽  
◽  
Ruxandra-Nicoleta Horodinschi ◽  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Distal Segment ◽  
Artery Occlusion ◽  
Fractional Flow ◽  
Circumflex Artery ◽  
Flow Reserve ◽  
Malignant Arrhythmia ◽  
Significant Life ◽  
The Right

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.

scholarly journals Malignant Arrhythmia in Acute Conus Artery Occlusion

2021 ◽  
Vol 3 (2) ◽  
pp. 1-4
Author(s):  
Diana Stanciulescu ◽  
◽  
Lucian Calmac ◽  
Ruxandra-Nicoleta Horodinschi ◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Distal Segment ◽  
Artery Occlusion ◽  
Fractional Flow ◽  
Circumflex Artery ◽  
Flow Reserve ◽  
Malignant Arrhythmia ◽  
Significant Life ◽  
The Right

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.

scholarly journals Anomalous aortic origin of the right coronary artery with functional ischemia determined with fractional flow reserve derived from computed tomography

2018 ◽  
Vol 6 (7) ◽  
pp. 1371-1372 ◽  
Author(s):  
Takashi Miki ◽  
Toru Miyoshi ◽  
Atsuyuki Watanabe ◽  
Kazuhiro Osawa ◽  
Naofumi Amioka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Right Coronary Artery ◽  
Fractional Flow ◽  
Flow Reserve ◽  
The Right

Side branch FFR after provisional stenting: simplified approach based on OCT frame count

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kini ◽  
N Okamoto ◽  
N Barman ◽  
Y Vengrenyuk ◽  
K Yasumura ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Functional Significance ◽  
Area Under The Curve ◽  
Side Branch ◽  
Funding Source ◽  
Fractional Flow ◽  
Simplified Approach ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Abstract Background/Introduction Treatment of bifurcation coronary artery lesions remains a major challenge in interventional cardiology. Side branch (SB) stenoses are frequently observed after stent implantation in bifurcation lesions, although angiographically narrowed SBs may not be functionally significant. Fractional flow reserve (FFR), a pressure-derived index of the hemodynamic significance of a coronary artery stenosis, may be useful in determining whether additional intervention is required in jailed SBs. Angiography and intravascular ultrasound (IVUS) derived parameters have showed poor diagnostic accuracy in predicting the functional significance of jailed SBs. Purpose The aim of the present study was to use high resolution optical coherence tomography (OCT) imaging to predict functionally significant SB stenoses after provisional stenting defined as SB FFR ≤0.80. Methods Seventy-one patients with 71 calcified bifurcation lesions with angiographically intermediate SB stenoses undergoing provisional stenting were enrolled in the prospective study. OCT pullbacks were performed before and after stent placement, and SB FFR was measured after main vessel stenting. SB ostium area (SBOA) was assessed using three-dimensional OCT cut-plane analysis off-line. In addition, we developed a simplified approach to SB ostium assessment based on SB ostium frame count using two-dimensional OCT pullback not requiring off-line 3D reconstruction. For the analysis, consecutive frames were counted between the most distal and most proximal take-off of the SB frames. Results Similar to previous studies, quantitative coronary angiography findings were not associated with the functional significance of SBs after main vessel stenting. In contrast, SBOA assessed by 3D-OCT after provisional stenting strongly correlated with post-procedure SB FFR. The optimal cut-off value for the SBOA area to predict a SB FFR ≤0.80 was 0.76 mm2 (sensitivity 82%, specificity 89% and area under the curve of 0.92 (95% CI: 0.84–0.99). A simplified approach to SB ostium assessment using OCT frame count yielded a sensitivity of 82%, specificity 89% and area under the curve 0.92 (95% CI: 0.84 to 0.99) with a cut-off of 4.5 frames allowing detection of functionally significant SB stenoses during the procedure in real time. Figure 1 shows a receiver-operating characteristic curve for SB FFR ≤0.8 and a representative case with SB FFR = 0.66 after provisional stenting and SB ostium frame count equal 3 (Frame 1 to 3) Conclusion(s) Assessment of SB using either 3D OCT off-line reconstruction or a simplified approach based on OCT frame count can detect SB branches with FFR ≤0.80 with high sensitivity and specificity. The developed approaches may represent a useful tool to assess provisional stent outcomes. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific; St. Jude Medical

Abstract 14685: Efficacy of Combined Administration of Intracoronary Papaverine and Intravenous Adenosine 5’-Triphosphate in Assessment of Fractional Flow Reserve

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takeshi Nishi ◽  
Yoshihide Fujimoto ◽  
Yoshio Kobayashi
Keyword(s):  
Coronary Artery ◽  
Ventricular Arrhythmia ◽  
Fractional Flow Reserve ◽  
Left Coronary Artery ◽  
Shortness Of Breath ◽  
Fractional Flow ◽  
Ventricular Premature Contraction ◽  
Flow Reserve ◽  
Combined Administration ◽  
The Right

Purpose: Inducing maximal coronary hyperemia is important to measure fractional flow reserve (FFR) accurately. Administration of intracoronary (IC) papaverine and intravenous (IV) adenosine 5’-triphosphate (ATP) have been used to achieve maximal hyperemia in the assessment of FFR. However, they may not induce maximal hyperemia in all patients. We aimed to evaluate combined effect of IC papaverine and IV ATP on FFR measurements. Methods: FFR measurements using administration of IC papaverine (12 mg in the left coronary artery and 8 mg in the right coronary artery), IV ATP (140 μg/kg/min), and the combination of IC papaverine plus IV ATP (additional IC bolus infusion of papaverine during IV ATP) were performed in 57 lesions of 52 consecutive patients. FFR values, symptoms, development of atrioventricular block (AVB), and ventricular arrhythmia were recorded. Results: Mean FFR values with IC papaverine, IV ATP, and the combination of IC papaverine and IV ATP were comparable (0.75 ± 0.13 vs. 0.76 ± 0.13 vs. 0.75 ± 0.13, p = 0.87). The proportion of lesions with a positive FFR (FFR ≤0.80) were not significantly different between the 3 methods (54.4% vs. 47.4% vs. 64.9%, p = 0.17). IC papaverine and IV ATP detected 25 lesions and 32 lesions with a negative FFR (FFR > 0.80), respectively. Of these, 7 (28%) and 11 lesions (34%) showed positive FFR with the combination of IC papaverine and IV ATP. Within the region of physiologically intermediate FFR values (0.75 to 0.85 obtained by IV ATP), there were significant differences in the FFR values (0.81 ± 0.02 vs. 0.79 ± 0.03, p = 0.01) and the proportion of positive FFR (48.3% vs. 66.7%, p < 0.01) between IV ATP and the combination of IC papaverine and IV ATP. IC papaverine increased ventricular premature contraction in 2%. IV ATP caused flushing in 48%, chest oppression in 27%, shortness of breath in 10%, and transient 2nd degree AVB in 3%. The combination of IC papaverine and IV ATP caused transient 2nd degree AVB in 2%. Conclusions: The hyperemic efficacy of IC papaverine or IV ATP alone is suboptimal in some patients. Combined administration of IC papaverine and IV ATP can achieve optimal hyperemia in such patients and has the potential to assist in making clinical decisions on patients with physiologically intermediate lesions.

Abstract 10976: Diagnostic Ability of Contrast Media Induced Fractional Flow Reserve to Assess Functional Significance of Entire Coronary Artery Stenosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hiroaki Takashima ◽  
Akiyoshi Kurita ◽  
Yuki Saka ◽  
Katsuhisa Waseda ◽  
Hirohiko Ando ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Contrast Media ◽  
Functional Significance ◽  
Entire Range ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Fractional Flow ◽  
Diagnostic Ability ◽  
Flow Reserve ◽  
Lesion Severity

Introduction: Although fractional flow reserve (FFR) is helpful to evaluate functional lesion severity, the need of adenosine limits the widespread adoption of FFR. Hypothesis: We hypothesized that contrast media induced FFR (cFFR) with submaximal hyperemic condition could assess functional lesion severity of coronary artery stenos. The aim of this study was to evaluate the diagnostic ability of cFFR compared to FFR in entire range of coronary artery stenosis. Methods: A total of 96 patients with 123 lesions were prospectively enrolled in this study. At first, we measured resting Pd/Pa ratio before inducing hyperemia. Then, cFFR was obtained after intracoronary injection of 6 ml of contrast media, while FFR was measured after intravenous adenosine triphosphate administration (180 mcg/kg/min). Lesions with FFR less than or equal 0.80 were considered functional significance of coronary artery stenosis. Results: In 123 lesions, reference diameter, diameter stenosis, resting Pd/Pa ratio, cFFR, and FFR were 2.7±0.8 mm, 47±12%, 0.91±0.10, 0.83±0.12, and 0.81±0.12, respectively. Functional significance was observed in 41% of all lesions. Both of resting Pd/Pa and cFFR showed strong correlations with FFR (r=0.861, p<0.001, and r=0.930, p<0.001, respectively). The correlation coefficient of cFFR was significantly superior to that of resting Pd/Pa ratio (p<0.05). This strong correlation between cFFR and FFR was shown in every coronary artery (LAD; r=0.924, p<0.001, LCX; r=0.923, p<0.001, and RCA; r=0.926, p<0.001, respectively). The Bland-Altman plot demonstrated a good agreement with a mean difference of -0.02 and a standard deviation of 0.05 between cFFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of cFFR <0.84 in predicting functional significance (AUC 0.96, sensitivity 90%, specificity 89%, and diagnostic accuracy 89%). Moreover, the cFFR >0.89 was not corresponded to functional significance of entire coronary artery stenosis. Conclusions: The cFFR is an accurate, rapid and easy method in predicting functional significance of entire coronary artery stenosis. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.

Sign in / Sign up

Export Citation Format

Share Document