Fractional flow reserve-guided ‘spot stenting’ in intermediate coronary stenosis—a case report

Abstract

Correspondence: Dr. Aniket Puri, Associate Professor, Department of Cardiology, CSM Medical University, Lucknow, UP. E-mail: aniketpuri@hotmail.com Fractional flow reserve is an index of the physiological significance of a coronary stenosis and is defined as the ratio of maximal blood flow in a stenotic artery to normal maximal flow.4 It can be measured during coronary angiography by calculating the ratio of distal coronary pressure measured with a coronary pressure guidewire to aortic pressure measured simultaneously with the guiding catheter. FFR in a normal coronary artery equals 1.0. The information provided by FFR is similar to that obtained with myocardial perfusion studies, but it is more specific and has a better spatial resolution, because every artery or segment is analyzed separately, and masking of one ischemic area by another, more severely ischemic, zone is avoided.5,6 Deferring percutaneous coronary intervention (PCI) in nonischemic stenotic lesions, as assessed by FFR, is associated with very low annual rate of death or MI, as was seen in DEFER trial patients,2 whereas deferring PCI in lesions with an FFR of 90%.4,7,8 The recent data from recent FAME9 trial has shown that 0.80 is more accurate value to identify truly ischemic lesions. Retrospective studies suggest that in patients with multivessel coronary artery disease, FFRguided PCI is associated with a favorable outcome with respect to event-free survival.10 We report a case of FFR-guided PCI, which highlights the importance of assessment of functional significance and its contribution in proper clinical decision making.