Abstract
Fractional flow reserve has become the mainstay of functional hemodynamic assessment and is considered the gold standard to identify ischemic coronary stenoses. However, adopting the method into daily practice has been limited. Indeed, it requires the use of a costly pressure wire and the administration of a hyperemic agent. Vessel fractional flow reserve is a 3D-QCA based fractional flow reserve, using CAAS Workstation (version 8.4; Pie Medical Imaging, Maastricht, the Netherlands). It is a non-invasive method that does not require pressure wire or hyperemic agent; therefore it is time saving and easy to use. This is the first case performed in Brazil and demonstrates the correlation between fractional flow reserve and vessel fractional flow reserve performed in the same lesion, and the feasibility of calculation of vessel fractional flow reserve using 3D QCA-based software. We report the case of a 61-year-old male, who was admitted for typical chest pain. Coronary angiography revealed serial intermediate lesions in the mid- and distal left anterior descending. We evaluated left anterior descending lesions initially by fractional flow reserve then by vessel fractional flow reserve. Fractional flow reserve in distal left anterior descending was 0.65. Then, vessel fractional flow reserve value was calculated at 0.61. In our case, the correlation was adequate and the feasibility with offline calculation was excellent and fast. To the best of our knowledge, this is the first case of vessel fractional flow reserve performed in Latin America. Therefore, we expect vessel fractional flow reserve to be a game changer in management of coronary artery disease patients, particularly those with intermediate lesions.
Highlights
Invasive coronary angiography has served as the cornerstone for the diagnosis of patients with known or suspected coronary artery disease (CAD)
Vessel fractional flow reserve is a 3D-QCA based fractional flow reserve, using CAAS Workstation. It is a non-invasive method that does not require pressure wire or hyperemic agent; it is time saving and easy to use. This is the first case performed in Brazil and demonstrates the correlation between fractional flow reserve and vessel fractional flow reserve performed in the same lesion, and the feasibility of calculation of vessel fractional flow reserve using 3D QCA-based software
We evaluated left anterior descending lesions initially by fractional flow reserve by vessel fractional flow reserve
Summary
Invasive coronary angiography has served as the cornerstone for the diagnosis of patients with known or suspected coronary artery disease (CAD). The technique is limited by inaccuracy of visual estimation to assess the hemodynamic impact of intermediate coronary artery stenosis. This might result in either underestimation or overestimation of CAD severity.[1]. Fractional flow reserve (FFR) has emerged as the mainstay of functional hemodynamic assessment of lesions, and is considered the gold standard to identify ischemic coronary stenoses.[2] Despite indisputable evidence supporting the benefit of FFR to guide clinical decision-making process, its adoption into daily practice has been limited in many countries. FFR assessment requires the use of a costly pressure wire or micro-catheter, along with the administration of a hyperemic agent that might cause temporary patient discomfort.[3]
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