Abstract
Background: Fractional flow reserve (FFR) measurement can aid in the assessment of left main coronary stenosis. We have previously shown in an animal model that the presence of downstream epicardial stenosis can affect left main FFR measurement. The aim of this study is to explore the effect of stenosis in a downstream epicardial artery on left main FFR assessment in humans. Methods: After elective coronary intervention of either the left anterior descending (LAD) or left circumflex (LCX) artery, an intermediate left main stenosis was created using an uninflated “winged” balloon. Variable stenoses were then created in the downstream vessel using a balloon inflated within the newly placed stent. A total of 67 pairs of left main FFR assessments in 16 patients were obtained, before and after creation of a stenosis in the downstream vessel, with a pressure wire in the nonstenosed downstream vessel. Results: The apparent left main FFR in the presence of downstream stenosis (FFRapp) was modestly higher than the true FFR in the absence of downstream stenosis (FFRtrue) (0.82 0.07vs.0.80 0.07, p 0.5, and the FFRepicardial was <0.2 in both cases.
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