scholarly journals Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ran Kornowski ◽  
Hana Vaknin-Assa
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Clinical Decision Making ◽  
Guide Wire ◽  
Coronary Revascularization ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Fractional Flow ◽  
Flow Reserve ◽  
On Line

Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. FFRangio is a novel technology that uses the patient’s hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between FFRangio and invasive FFR was observed. In light of the demonstrated capabilities of the FFRangio system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease.

scholarly journals DISENGAGE Registry

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Mariano Pellicano ◽  
Giovanni Ciccarelli ◽  
Panagiotis Xaplanteris ◽  
Giuseppe Di Gioia ◽  
Anastasios Milkas ◽  
...  
Keyword(s):  
Decision Making ◽  
Fractional Flow Reserve ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Coronary Ostium ◽  
Fractional Flow ◽  
Flow Reserve ◽  
The Impact ◽  
Guiding Catheter ◽  
Hyperemic Flow

Background: During fractional flow reserve (FFR) measurement, the simple presence of the guiding catheter (GC) within the coronary ostium might create artificial ostial stenosis, affecting the hyperemic flow. We aimed to investigate whether selective GC engagement of the coronary ostium might impede hyperemic flow, and therefore impact FFR measurements and related clinical decision-making. Methods: In the DISENGAGE (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, FFR was prospectively measured twice (with GC engaged [FFR eng ] and disengaged [FFR dis ]) in 202 intermediate stenoses of 173 patients. We assessed (1) whether ΔFFR eng –FFR dis was significantly different from the intrinsic variability of repeated FFR measurements (test-retest repeatability); (2) whether the extent of ΔFFR eng –FFR dis could be clinically significant and therefore able to impact clinical decision-making; and (3) whether ΔFFR eng –FFR dis related to the stenosis location, that is, proximal and middle versus distal coronary segments. Results: Overall, FFR significantly changed after GC disengagement: FFR eng 0.84±0.08 versus FFR dis 0.80±0.09, P <0.001. Particularly, in 38 stenoses (19%) with FFR values in the 0.81 to 0.85 range, GC disengagement was associated with a shift from above to below the 0.80 clinical cutoff, resulting into a change of the treatment strategy from medical therapy to percutaneous coronary intervention. The impact of GC disengagement was significantly more pronounced with stenoses located in proximal and middle as compared with distal coronary segments (ΔFFR eng –FFR dis , proximal and middle 0.04±0.03 versus distal segments 0.03±0.03; P =0.042). Conclusions: GC disengagement results in a shift of FFR values from above to below the clinical cutoff FFR value of 0.80 in 1 out of 5 measurements. This occurs mostly when the stenosis is located in proximal and middle coronary segments and the FFR value is close to the cutoff value.

scholarly journals Maxillofacial Prosthesis for Combined Intra and Extra-Oral Defect – A Case Report

2021 ◽  
Vol 10 (8) ◽  
pp. 550-554
Author(s):  
Rajiv Dharampal Bhola ◽  
Sweta Gajanan Kale Pisulkar ◽  
Surekha Anil Dubey Godbole ◽  
Hetal Satish Purohit ◽  
Anjali Bhoyar Borle
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Upper Lip ◽  
Facial Prosthesis ◽  
Maxillofacial Prosthesis ◽  
Facial Defects ◽  
Cancerous Lesion ◽  
Orbital Defects

Combined intra and extra oral defects can be stated as those facial defects which have an intraoral communicating route. Midfacial defects are aptly classified into 2 major categories by Marunick et al. 1 as midline midfacial defects in which the nose and / or upper lip defects are included; and the second major group was lateral defects in which the cheek and orbital defects are categorized. However, defects which include combinations of the above-mentioned defects are in existence. Midfacial defects which are acquired, present themselves often with severe disfigurement of structures and hence show impaired function. It is a meticulous task to rehabilitate the defects which are caused as a result of cancerous lesion resection as they are huge. Such post resection lesions frequently are rehabilitated by a facial prosthesis to maintain function as well as the appearance in the normal form. In adjunction to the facial prosthesis, an intraoral prosthesis which constitutes of an obturator is also required to regain the natural speech and pattern of swallowing. Fabrication of such facial prosthesis not only requires the artistic capability but also excellent clinical decision making of the prosthodontist. Mode of retention of the combined prosthesis should also be kept in mind while fabricating as it is also a difficult task to retain them because of the size and weight of the same. Moreover the prosthesis should also be secured in its place with these aids which can also prove as a challenge. This case report states rehabilitating a large surgically resected midfacial defect with the assistance of a “3-piece prosthesis” which constitutes a sectional intraoral obturator along with maxillary and mandibular extraoral facial prosthesis.

In-Vivo Evaluation of Severity of Microvascular Impairments and Epicardial Coronary Stenoses Using Fundamental Fluid Dynamics Endpoints

2008 ◽  
Author(s):  
Koustubh D. Ashtekar ◽  
Edward Kim ◽  
Abhijit S. Roy ◽  
Tarek A. Helmy ◽  
Mohamed A. Effat ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Fractional Flow ◽  
In Vivo Evaluation ◽  
Flow Reserve ◽  
Coronary Stenoses ◽  
Decision Making Processes ◽  
Epicardial Stenosis ◽  
Treatment Procedures

Coronary circulation is mainly regulated by two serial resistances, namely, epicardial stenosis and microvascular impairments, both causing abnormal coronary blood circulation [1]. Delineation of the true severities of these diseases is important to guide clinical decision-making processes for the selection of appropriate treatment procedures [2]. The presently used diagnostic parameters: FFR (fractional flow reserve defined as the ratio of distal to proximal hyperemic pressure) and CFR (coronary flow reserve defined as ratio of basal to hyperemic flow) [1], for the evaluation of severity of epicardial coronary stenosis are well established in clinical practice. On the other hand, current methods to evaluate the microcirculatory status are limited [3].

Three-dimensional surface imaging for clinical decision making in pectus excavatum

2021 ◽  
Author(s):  
Jean H.T. Daemen ◽  
Nadine A. Coorens ◽  
Karel W.E. Hulsewé ◽  
Thomas J.J. Maal ◽  
Jos G. Maessen ◽  
...  
Keyword(s):  
Decision Making ◽  
Pectus Excavatum ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Surface Imaging ◽  
Dimensional Surface
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