By Tommaso Gori, Massimo Fineschi
This ebook stories the idea and perform of fractional circulation reserve (FFR)-guided coronary intervention, a method that provides experience and a reason to day-by-day judgements within the interventional suite. FFR tips presents certain details on coronary hemodynamics for the interventional heart specialist. this system has profound sensible implications for healing judgements and for the diagnosis of sufferers.
The Atlas of FFR-Guided Percutaneous Coronary Interventions presents practising physicians transparent details to appreciate either the complexity of the strategy and the proper method to practice it. it truly is designed either to aid more youthful college and people in education, and to behave as a medical source for more matured practitioners. utilizing the scientific situations defined, the reader can learn how to get pleasure from the pitfalls, tips and tips that simplify the functionality and interpretation of FFR and iFR.
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Extra resources for Atlas of FFR-Guided Percutaneous Coronary Interventions
43 5, 7 Clinical Decision-Making The first FFR assessment confirmed the functional significance of the angiographic stenosis. This is particularly important in a 3-vessel disease patient, since FFR can downgrade the patient to 1 or 2-vessel disease, therefore influencing the decision between PCI and surgery. , above the threshold of hemodynamic significance but still demonstrating the presence of diffuse atherosclerosis. Based on the FFR findings, and in the absence of a focal pressure drop, it was decided not to proceed with stenting in the proximal segment.
8 When the Pd/Pa Is Already Significant: A “Quick and Clean” FFR Final Comments FFR assessment becomes very easy and quick if the gradient is already present at baseline. A practical algorithm is presented in (Fig. 3). FFR quantifies the severity of coronary stenoses and, based on the results of the DEFER, FAME 1 and 2 trials (see Chap. 1), is considered a gold standard for this purpose. iFR and Pd/Pa are non-hyperemic pressurederived indexes which, despite being less validated in large multicentric trials, have the potential to provide relevant information avoiding the complications associated with hyperemic agents.
In the paper by Leesar et al. 95 was associated with improved outcomes. 0 (without focal pressure drop) Fig. 94. Suggested Readings Leesar MA, Satran A, Yalamanchili V, Helmy T, Abdul-Waheed M, Wongpraparut N. The impact of fractional flow reserve measurement on clinical outcomes after transradial coronary stenting. Euro Intervention. 2011;7(8):917–23. Nam CW1, Hur SH, Cho YK, Park HS, Yoon HJ, Kim H, et al. Relation of fractional flow reserve after drug-eluting stent implantation to one-year outcomes.