Skip to main content
SpringerLink
Log in

FFR in Complex Lesions

  • Chapter
  • First Online:
Coronary Imaging and Physiology

  • 1847 Accesses

Abstract

Complex coronary lesion subset include bifurcation, left main, serial lesions, and multivessel disease still remained as controversies in decision of revascularization. Invasive physiologic assessment such as FFR can guide the need of revascularization and reduce unnecessary complicated intervention in complex lesion subset. Application of FFR on the complex lesion subsets requires a comprehensive understanding of physiologic and anatomical findings and pitfalls in specific complex lesions. In this section, recent update would be provided on the physiologic assessment in complex coronary lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Shin DH, Koo BK, Waseda K, Park KW, Kim HS, Corral M, et al. Discrepancy in the assessment of jailed side branch lesions by visual estimation and quantitative coronary angiographic analysis: comparison with fractional flow reserve. Catheter Cardiovasc Interv. 2011;78:720–6.

    Article  PubMed  Google Scholar 

  2. Ahn JM, Lee JY, Kang SJ, Kim YH, Song HG, Oh JH, et al. Functional assessment of jailed side branches in coronary bifurcation lesions using fractional flow reserve. JACC Cardiovasc Interv. 2012;5:155–61.

    Article  PubMed  Google Scholar 

  3. Koo BK, Kang HJ, Youn TJ, Chae IH, Choi DJ, Kim HS, et al. Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol. 2005;46:633–7.

    Article  PubMed  Google Scholar 

  4. Koh JS, Koo BK, Kim JH, Yang HM, Park KW, Kang HJ, et al. Relationship between fractional flow reserve and angiographic and intravascular ultrasound parameters in ostial lesions: major epicardial vessel versus side branch ostial lesions. JACC Cardiovasc Interv. 2012;5:409–15.

    Article  PubMed  Google Scholar 

  5. Chen SL, Ye F, Zhang JJ, Xu T, Tian NL, Liu ZZ, Lin S, et al. Randomized comparison of FFR-guided and angiography-guided provisional stenting of true coronary bifurcation lesions: the DKCRUSH-VI trial (double kissing crush versus provisional stenting technique for treatment of coronary bifurcation lesions VI). JACC Cardiovasc Interv. 2015;8:536–46.

    Article  PubMed  Google Scholar 

  6. Koo BK, Lee SP, Lee JH, Park KW, Suh JW, Cho YS, et al. Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions. JACC Cardiovasc Interv. 2012;5:1126–32.

    Article  PubMed  Google Scholar 

  7. Campeau L, Corbara F, Crochet D, Petitclerc R. Left main coronary artery stenosis: the influence of aortocoronary bypass surgery on survival. Circulation. 1978;57:1111–5.

    Article  CAS  PubMed  Google Scholar 

  8. Chaitman BR, Fisher LD, Bourassa MG, Davis K, Rogers WJ, Maynard C, et al. Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the collaborative study in coronary artery surgery (CASS). Am J Cardiol. 1981;48:765–77.

    Article  CAS  PubMed  Google Scholar 

  9. Taylor HA, Deumite NJ, Chaitman BR, Davis KB, Killip T, Rogers WJ. Asymptomatic left main coronary artery disease in the coronary artery surgery study (CASS) registry. Circulation. 1989;79:1171–9.

    Article  CAS  PubMed  Google Scholar 

  10. Hamilos M, Muller O, Cuisset T, Ntalianis A, Chlouverakis G, Sarno G, et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation. 2009;120:1505–12.

    Article  PubMed  Google Scholar 

  11. Lindstaedt M, Spiecker M, Perings C, Lawo T, Yazar A, Holland-Letz T, et al. How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses? Int J Cardiol. 2007;120:254–61.

    Article  PubMed  Google Scholar 

  12. Park SJ, Kang SJ, Ahn JM, Shim EB, Kim YT, Yun SC, et al. Visual-functional mismatch between coronary angiography and fractional flow reserve. JACC Cardiovasc Interv. 2012;5:1029–36.

    Article  PubMed  Google Scholar 

  13. Park SJ, Ahn JM, Kang SJ, Yoon SH, Koo BK, Lee JY, et al. Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis. JACC Cardiovasc Interv. 2014;7:868–74.

    Article  PubMed  Google Scholar 

  14. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:2574–609.

    Article  PubMed  Google Scholar 

  15. Mallidi J, Atreya AR, Cook J, Garb J, Jeremias A, Klein LW, et al. Long-term outcomes following fractional flow reserve-guided treatment of angiographically ambiguous left main coronary artery disease: a meta-analysis of prospective cohort studies. Catheter Cardiovasc Interv. 2015;86:12–8.

    Article  PubMed  Google Scholar 

  16. Fearon WF, Yong AS, Lenders G, Toth GG, Dao C, Daniels DV, et al. The impact of downstream coronary stenosis on fractional flow reserve assessment of intermediate left main coronary artery disease: human validation. JACC Cardiovasc Interv. 2015;8:398–403.

    Article  PubMed  Google Scholar 

  17. Pijls NH, De Bruyne B, Bech GJ, Liistro F, Heyndrickx GR, Bonnier HJ, et al. Coronary pressure measurement to assess the hemodynamic significance of serial stenoses within one coronary artery: validation in humans. Circulation. 2000;102:2371–7.

    Article  CAS  PubMed  Google Scholar 

  18. Kim HL, Koo BK, Nam CW, Doh JH, Kim JH, Yang HM, et al. Clinical and physiological outcomes of fractional flow reserve-guided percutaneous coronary intervention in patients with serial stenoses within one coronary artery. JACC Cardiovasc Interv. 2012;5:1013–8.

    Article  PubMed  Google Scholar 

  19. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, FAME Study Investigators, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    Article  CAS  PubMed  Google Scholar 

  20. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, SYNTAX Investigators, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.

    Article  CAS  PubMed  Google Scholar 

  21. Nam CW, Mangiacapra F, Entjes R, Chung IS, Sels JW, Tonino PA, FAME Study Investigators, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol. 2011;58:1211–8.

    Article  PubMed  Google Scholar 

  22. Sachdeva R, Agrawal M, Flynn SE, Werner GS, Uretsky BF. Reversal of ischemia of donor artery myocardium after recanalization of a chronic total occlusion. Catheter Cardiovasc Interv. 2013;82:E453–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sejong General Hospital, Bucheon, South Korea

    Hyun-Jong Lee

  2. Inje University Ilsan Paik Hospital, Goyang, South Korea

    Joon-Hyung Doh

Authors
  1. Hyun-Jong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joon-Hyung Doh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joon-Hyung Doh .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Severance Cardiovascular Hospital , Seoul, Korea (Republic of)

    Myeong-Ki Hong

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Cite this chapter

Lee, HJ., Doh, JH. (2018). FFR in Complex Lesions. In: Hong, MK. (eds) Coronary Imaging and Physiology. Springer, Singapore. https://doi.org/10.1007/978-981-10-2787-1_27

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-2787-1_27

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-2786-4

  • Online ISBN: 978-981-10-2787-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation