C30. Clinical Decision Making in Intermediate Coronary Stenosis: Role of Fractional Flow Reserve

Abstract

Abstract Background Coronary stenosis can be managed by percutaneous coronary intervention (PCI). However, it has limitation by producing only 2D images of the actual 3D vascular lumen. It is necessary to assess the functional significance of stenosis with fractional flow reserve (FFR). Case Summary There are two patients in this case. The first patient was a 52-year-old man with typical chest pain, with a history of PCI in LAD 2 years earlier. Echocardiography revealed regional wall motion abnormality (RWMA) with reduced left ventricular ejection fraction (LVEF) of 30-40%. PCI with FFR guidance was performed. Previous stent in osteal-distal LAD was patent. In the distal LAD, a stenosis of 60-70% was obtained with FFR of 0.81. In distal LCX, 50-60% stenosis was also obtained with FFR of 0.91. No stent was implanted then. The second patient was a 59-year-old man with typical chest pain. The patient had been stented in proximal-mid LAD and LCX-OM a year earlier. Echocardiography showed RWMA with LVEF of 51-54%. LAD and LCX stents were patent. A 70-80% stenosis was found in both mid and distal RCA. FFR was done in the mid-RCA with result of 0.57, so stent was placed in the mid RCA. FFR at distal RCA was 0.31 so that the stent was also placed in the distal RCA. Both showed good results. Discussion Physiologic assessment is important before deciding to revascularize. FFR-guided PCI is expected to better guide us in managing intermediate coronary stenosis.