FFR guided PCI in multivessel disease

- Operator : Seung-Jung Park

FFR guided PCI in multivessel disease
- Operator: Seung-Jung Park, MD
Cilinical history

A 61-year-old man was admitted to our hospital due to exertional angina for 2 years. He had diabetes and hyperlipidemia. His clinical examiniation did not reveal any significant findings. Echocardiography reveals no gross regional wall motion abnormality with LVEF ~64%.

Coronary angiographic findings

1) Rt. coronary angiography showed diffuse 50-90% stenosis from proximal to distal part of right coronary arery (RCA). ( Movie 1)
2) Lt. coronary angiography showed significantly diffuse stenotic lesions in the left main (LM) ostium and left anterior descending (LAD) and in the left circumflex (LCX). ( Movie 2, Movie 3)

Procedure

First, the left coronary artery was engaged with a 7 Fr JL4 guiding catheter and 0.014¡± BMW guidewire was positioned in the LAD. Because we failed to pass IVUS catheter through the LAD, we performed angioplasty of the proximal-mid LAD. The lesion was predilated twice with a 2.5/15 mm Sprinte balloon at 8 atmospheres. A 3.0/24 mm Endeavor Resolute stent was deployed and high pressure balloon with Nimbus salbo 3.5/13 mm was done (Figure 1, Figure 2, Figure 3). And then, In order to evaluate the hemodynamic impct of these lesions, we performed fractional flow reserve (FFR) measurement in the LM and the LAD. A 0.014¡± pressure wire was used for the FFR measurement, while hyperemia was induced by intravenous adenosine administration. FFR was 0.84 and 0.91 in the prox-LAD and the LM respectively. Based on the above results we finished angioplasty of the mid-LAD. The RCA was engaged with a 7 Fr JR4 guiding catheter and we performed FFR for the RCA lesion at the same manner. FFR was 0.7 in the distal RCA and 0.74 in the mid RCA. Then RCA was wired with the same BMW guidewire. Proximal-mid diffusely diseased segment was predilated by 2.5/15 mm Sprinte balloon at 10 atmospheres, stented by Endeavor Resolute stent 3.5/30 mm at 12 atmospheres and then high pressure balloon with Nimbu salbo 3.5/13 mm was done(Figure 4, Figure 5, Figure 6). We checked FFR again and FFR value at the distal RCA was 0.90. Based on the above results, we finished this procedure.

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