FFR en bifurcaciones.pdf

8/10/2019 FFR en bifurcaciones.pdf

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Dr Ch. Martinez, CHU Sart Tilman, Belgium

Fractional Flow Reserve, when and why ?

Evaluation of the provisional side-branch strategy

for bifurcation lesion using FFR

Ch. Martinez, MD

University Hospital of Lige

Belgium

I do not have any potential conflict of interest


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Evaluation of the provisional side-branch intervention

strategy for bifurcation lesion using FFR: Introduction

I. Even and specially with DES, bifurcation lesionsremains one of the most challenging lesion subset

in coronary intervention

II. No previous study as shown benefit for the 2

stents strategy, even with DES

III. The provisional side-branch strategy is actuallyconsidered as the best for bifurcation lesions


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Evaluation of the provisional side-branch intervention

strategy for bifurcation lesion using FFR: Introduction

I. The decision making for SB interventions remains

problematic

II. The visual estimation of severity for such lesions

is very difficult

III. QCA systems are frequently inaccurate and does

not reflect the functional severity of such complex

and ostial lesions


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The FFR guided side-branch strategy

Koo BK and al, Eur Heart J. 2008 Mar;29(6):726-32.

Stenting of the main branch with DES

IC Nitroglycerin

Visual estimation

Residual stenosis > 50 % Residual stenosis < 50 %

FFR measurement

0.014 pressure wireIC adenosine bolus

+

IC adenosine infusion

Stop intervention


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FFR measurement

FFR < 0.75

Functionally significant

residual stenosis

FFR > 0.75No functionally significant

Residual lesion

Kissing balloon PTCA

+

FFR again

Stop interventionIf FFR < 0.75

Kissing stenting


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Clinical case: 60 years old man with unstable angina

Direct stenting

with a BMS 3.5 x 23


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Clinical case: 60 years old man with unstable angina


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3 month later, recurrent angina at rest


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3 month later, in-stent diffuse restenosis with side-

branch involved


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two conventional wires


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Pre-PTCA of side-branch because TIMI 2 flow


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Control after stenting => pressure wire


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FFR measurement: 0.71


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Kissing balloon PTCA


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FFR measurement after kissing balloon: 0.9


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Angiographic result after kissing balloon


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Percentage of SB lesions requiring further intervention at each

step of the FFR guided strategy: comparison of angiographic

and functional criteria.

0

10

20

30

40

5060

70

Post-stent Post-kissing Follow-up

> 75 % Stenosis FFR < 0.75

68%

31% 32%

8%

48%

8%



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Conclusion

Measurement of FFR can be helpful in determining

functional significance of lesions at each step of the

provisional side branch intervention strategy

FFR en bifurcaciones.pdf

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