Abstract
Fractional flow reserve (FFR) is routinely used to determine lesion severity prior to percutaneous coronary intervention (PCI). However, there is an increasing recognition that FFR may also be useful following PCI to identify mechanisms leading to restenosis and the need for repeat revascularization. Post-PCI FFR is associated with the presence and severity of stent under-expansion and may help identify peri-stent-related complications. FFR pullback may also unmask other functionally significant lesions within the target vessel that were not appreciable on angiography. Recent studies have confirmed the prognostic utility of performing routine post-PCI FFR and suggest possible interventional targets that would improve stent durability. In this review, we detail the theoretical basis underlying post-PCI FFR, provide practical tips to facilitate measurement, and discuss the growing evidence supporting its use.
Highlights
Clinical outcomes following revascularization with percutaneous coronary intervention (PCI) have improved significantly over the last three decades, driven by advances in stent design, improved PCI techniques, and enhanced adjuvant pharmacotherapies [1, 2]
Several studies have shown that a low fractional flow reserve (FFR) in a vessel following PCI is associated with poor clinical outcomes [8,9,10,11]. ese form part of the accumulating evidence which suggests that Fractional flow reserve (FFR) following PCI has an important clinical role in the functional optimization of PCI
Results from the DKCRUSH VII Registry Study revealed that left anterior descending artery (LAD) lesions were predictive of a suboptimal post-PCI FFR in drug eluting stent (DES) [7]. e concept of LAD/vessel specific post-PCI FFR cutoffs was introduced
Summary
Clinical outcomes following revascularization with percutaneous coronary intervention (PCI) have improved significantly over the last three decades, driven by advances in stent design, improved PCI techniques, and enhanced adjuvant pharmacotherapies [1, 2]. Suboptimal procedural results are a potentially modifiable cause of repeat target lesion and/or vessel revascularization [4]. Even when an optimal angiographic outcome has been achieved following PCI, use of intravascular imaging reveals incomplete stent expansion, strut malapposition, geographical plaque miss, or stent edge dissection in approximately 50% of cases [4]. Suboptimal stent deployment has been associated with abnormal pressure gradients across the stented segment. Several studies have shown that a low fractional flow reserve (FFR) in a vessel following PCI is associated with poor clinical outcomes [8,9,10,11]. We will discuss the physiological, theoretical, and clinical basis for the use of FFR for the assessment of stent deployment
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