FFR Guided Functional FFR Guided Functional FFR Guided Functional - - PowerPoint PPT Presentation

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Feb 15, 2024 393 likes •675 views

FFR Guided Functional FFR Guided Functional FFR Guided Functional FFR Guided Functional Angioplasty Angioplasty g g p p y y in Complex Anatomy in Complex Anatomy Jung-Min Ahn, MD g , Heart Institute Asan Medical Center Heart

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SLIDE 1

FFR Guided Functional FFR Guided Functional FFR Guided Functional Angioplasty FFR Guided Functional Angioplasty g p y in Complex Anatomy g p y in Complex Anatomy

Jung-Min Ahn, MD g , Heart Institute Asan Medical Center Heart Institute, Asan Medical Center

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SLIDE 2

Case 1. Case 1. Case 1. Case 1.

  • 45yo/M
  • 45yo/M
  • Chest pain for 4 months
  • Chest pain for 4 months
  • Risk factors : DM HTN ex smoking
  • Risk factors : DM, HTN, ex-smoking

C CT t th h it l Coronary CT at other hospital

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SLIDE 3

Coronary Angiogram Coronary Angiogram Coronary Angiogram Coronary Angiogram

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SLIDE 4

Coronary Angiogram Coronary Angiogram Coronary Angiogram Coronary Angiogram

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SLIDE 5

Coronary Angiogram Coronary Angiogram Coronary Angiogram Coronary Angiogram

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SLIDE 6

Result of CAG Result of CAG Result of CAG Result of CAG

  • Angiographic multivessel disease

(2 V l Di ) (2 Vessel Disease)

  • Really same findings with coronary CT

y g y

  • How to treat this patient ??

How to treat this patient ??

Just Stent it ?

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SLIDE 7

FFR & IVUS FFR & IVUS FFR & IVUS FFR & IVUS

FFR : 0.84

IVUS 3.3 mm2

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SLIDE 8

IVUS & FFR IVUS & FFR IVUS & FFR IVUS & FFR

FFR : 0.86 Angiographic 2 Vessel Disease Angiographic 2 Vessel Disease But, Functionally Normal Cornary

IVUS 2.2 mm2

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SLIDE 9

Visual-Functional Mismatch Visual-Functional Mismatch

From FAME Study

C Functionally Diseased Coronary Arteries

0VD (34%) 2VD (14%) 1VD (43%) ( ) J Am Coll Cardiol 2010;55:2816–21

Angiographic 2VD

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SLIDE 10

Non-Invasive functional study Non-Invasive functional study Non Invasive functional study Non Invasive functional study

  • Thallium SPECT : WNL
  • Thallium SPECT : WNL
  • TMT : Stage 4 HR 173 (97% of Target HR)
  • TMT : Stage 4, HR 173 (97% of Target HR)
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SLIDE 11

Case 2. Case 2. Case 2. Case 2.

  • 62yo/M
  • 62yo/M
  • Recurrent Chest pain for 1 year
  • Recurrent Chest pain for 1 year
  • Risk factors : None
  • Risk factors : None
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SLIDE 12

Coronary Angiogram Coronary Angiogram Coronary Angiogram Coronary Angiogram

LAD FFR 0.71 0.71

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SLIDE 13

How to Treat? How to Treat? How to Treat? How to Treat?

  • Simple cross over ?

T t t t h i ?

  • Two stent technique ?
  • Side branch protection ?

p

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SLIDE 14

Procedure Procedure Procedure Procedure

BMW in 1st Di & predilatation predilatation Promus Element 4.0(28) Promus Element 3.5(12)

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SLIDE 15

After Stent at Main Vessel After Stent at Main Vessel After Stent at Main Vessel After Stent at Main Vessel

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SLIDE 16

What Would You Do? What Would You Do? What Would You Do? What Would You Do?

FFR 0 84 FFR 0.84

Leave it alone.

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SLIDE 17

FFR of the Jailed Side Branch FFR of the Jailed Side Branch J S c J S c

1.0 rve 0.9

  • w Reser

0.8 ional Flo

Only 27%

0.7 Fracti

among SB with > 75% has FFR < 0.75

0.6

r=-0.464, p<0.001

Percent Stenosis (%) 40 50 60 70 80 90 100 0.5 Percent Stenosis (%) Koo BK et al JACC 2005; 46: 633

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SLIDE 18

Case 3. Case 3. Case 3. Case 3.

  • 47yo/M
  • 47yo/M
  • Recent onset chest pain
  • Recent onset chest pain
  • Risk factors : HTN
  • Risk factors : HTN
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SLIDE 19

Coronary Angiogram Coronary Angiogram Coronary Angiogram Coronary Angiogram

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SLIDE 20

Coronary Angiogram Coronary Angiogram Coronary Angiogram Coronary Angiogram

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SLIDE 21

IVUS & FFR IVUS & FFR IVUS & FFR IVUS & FFR

FFR : 0.84 FFR : 0.84

IVUS IVUS 4.8 mm2

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SLIDE 22

FFR of the Equivocal LMCA FFR of the Equivocal LMCA q

“Mismatch” is 29% in equivocal LMCA

80

sis

60

Stenos v

40

eter S v

20

Diame

R= 0 38 p<0 01 0.5 0.6 0.7 0.8 0.9

% D

R=-0.38, p<0.01 1.0 Circulation 2009;120:1505-1512 Isolated LMCA disease

FFR

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SLIDE 23

FFR guided PCI in Equivocal LMCA FFR guided PCI in Equivocal LMCA

  • In 213 patients with an equivocal LMCA stenosis
  • FFR ≥0 80: DEFER (n=138) vs FFR<0 80: CABG (n=75)

100 100

  • FFR ≥0.80: DEFER (n=138) vs. FFR<0.80: CABG (n=75)

100 80 100 80

ee

p=0 48 p=0 5 89.8% 85.4% 82.8% 74 2%

60 40

% Survival

60 40

% MACE fre

p=0.48 p=0.5

FFR≥0.80 FFR<0.80 FFR≥0.80 FFR<0.80

74.2%

20

%

20

%

Survival MACE

12 24 36 48 60 12 24 36 48 60 Months Months

An FFR-guided strategy show ed the favorable outcome.

  • Circulation. 2009;120:1505-1512
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SLIDE 24

How to Treat How to Treat

Angiographic multivessel disease

Functionally Functionally, Normal coronary artery We just used 2 stents, simple cross over to

Angiographic Jailed Side branch

p treat these lesion subset including g multivessel, bifurcation, and LM

Angiographic Isolated LM dz

, disease

All of them are still alive All of them are still alive

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SLIDE 25

Summary Summary Summary Summary

  • If you measured FFR in complex lesion

subset, you could find the simple functional anatomy from complex angiographic findings anatomy from complex angiographic findings

  • Therefore FFR measurement makes

Therefore, FFR measurement makes treatment simplified p

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SLIDE 26

“Simple” i th lti t hi ti ti “Simple” i th lti t hi ti ti is the ultimate sophistication... is the ultimate sophistication...

Leonardo Da Vinci said

0 80

Just FFR it

0.80

Just FFR it

DEFER PCI

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SLIDE 27

FFR measurement in Complex FFR measurement in Complex s C p lesions may lead to s C p lesions may lead to

① S t t d t ① Save stent and cost ② Avoid unnecessary PCI ③ Improve clinical outcomes of patients