Slides Imaging & Physiology
Decision Making Using with FFR (Fractional Flow Reserve) Guidance
- Operator : Antonio Colombo
Decision Making Using with FFR (Fractional Flow Reserve) Guidance |
- Operator: Antonio Colombo, MD |
Case Presentation |
A 74 year-old man was admitted with effort chest pain for 3 months. His coronary risk factors were hypertension, hyperlipidemia and ex-smoking. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=65%) without regional wall motion abnormality. Treadmill test is negative and thallium test showed reversible large perfusion defect of LCX territory. |
Baseline coronary angiography |
The left coronary angiogram showed tight stenosis of LM to proximal LAD, tubular stenosis of middle LAD, and diffuse narrowing of distal LCX ( Movie 1, Movie 2, Movie 3). The lesions at right coronary artery were not significant. |
Procedure |
A 7 Fr sheath was inserted through right femoral artery, and the left coronary ostium was engaged with a 7Fr XB 3.5 catheter with side hole. Two 0.014 inch BMW wires were inserted into the LAD and LCX. A 3.5 x 20mm Promus Element stent was directly implanted at LM to proximal LAD crossing LCX ostium without predilatation (Figure 1). A 3.0 x16 mm Promus Element stent was also implanted at middle LAD with predilatation and postdilatation using a 3.5 x 15mm Quantum balloon (Figure 2). After LAD stentings, we checked LCX FFR value using a pressure wire because of abnormal thallium result. LCX FFR value was 0.70. So we intended to treat LCX ostium using a kissing balloon angioplasty to improve LCX FFR value. A kissing balloon angioplasty was performed with a 3.5 x 15mm Quantum balloon for LAD and a 2.5 x 15mm Maverick balloon for LCX (Figure 3). After a kissing balloon angioplasty, rechecked LCX FFR value was 0.83. Final angiogram showed that the procedure was successful ( Movie 4, Movie 5, Movie 6). |
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