Abstract 14631: Assessment and Resolution of Complex Coronary Configurations by the Multi-artery Fractional Flow Reserve Method

Abstract

Introduction: Statistical studies have shown that an FFR method is superior to the traditional coronary assessment method based on angiographic appearance. The current FFR-oriented methods (resting P d / P a , wave-free iFR and hyperemic FFR) however, share a common downside: They do not consider inter arterial interactions and therefore cannot resolve multi-artery configurations, a vital capability provided by the novel multi-artery FFR method. Methods: An independent stand-alone stenotic coronary artery is characterized by its intrinsic FFR (denoted FFR true ). In a multi-artery configuration however, it is influenced by interconnected arteries and the treatment decision criteria apply to the actual FFR (denoted FFR real ) that reflects the arterial current condition. Seeking an optimal resolution of a stenotic configuration, outcomes (FFR true and FFR real ) of optional revascularizations are predicted and evaluated by the multi-artery FFR method. Results: In this work the multi-artery FFR method is applied to the stenotic unprotected configuration LMCA-LCx-LAD-M 2 (second obtuse marginal). The initial characteristics of the configuration are: FFR true (LMCA)=0.87 FFR true (LCx)=0.76 FFR true (LAD)=0.92 FFR true (M 2 )=0.93 FFR real (LMCA)=0.75 FFR real (LCx)=0.67 FFR real (LAD)=0.82 FFR real (M 2 )=0.63 After optimal resolution (by hyperemic FFR criteria), the final characteristics are: FFR true (LMCA)=0.87 FFR true (LCx)=1.00 FFR true (LAD)=1.00 FFR true (M 2 )=0.93 FFR real (LMCA)=0.87 FFR real (LCx)=0.87 FFR real (LAD)=0.87 FFR real (M 2 )=0.80 Conclusions: This work shows that a prerequisite for a successful resolution of a stenotic coronary configuration is a prior numerical simulation of the whole process in which the multi-artery FFR method is applied to the measured intracoronary pressures. This holds for each FFR-oriented method, preserving its specific experimental technique and treatment decision criteria. In conclusion, the multi-artery FFR method has the potential to introduce the PCI practice into an all new era in which the practitioner can devise a resolution strategy and test it by predicting outcomes (in terms of FFR true and FFR real of the arteries) of potential revascularizations, prior to actual implementation.