为什么我们需要FFR要点.ppt

* Notes: * Notes: * Notes: * Notes: * Notes: * Notes: * Notes: * Notes: * After stent 3.5 mm (mid-RCA) FFR = 0.80 Not optimal post stent result FFR Case Stent 3.5 mm (mid-RCA) + Stent 3.5 mm (prox-RCA) FFR = 0.94 Optimal post stent result FFR Case FFR 正常值=1，0.75-0.80灰色地带，FFR0.75,特异度100%； FFR不受血流动力学的影响（心率、血压等）； FFR解释了心外膜下血管的狭窄病变对远端心肌灌注血流的影响； FFR考虑了侧枝循环； FFR非常容易测量和有非常好的重复性； 通过PULL BACK方式，能对血管进行整体评估。 小结 血管造影术本身的局限性 形态学和功能学的差异 无创评估指标的局限性 不必要的使用药物支架的潜在不利因素 在冠脉造影中，结合测量FFR，可以给介入医生在制定治疗策略时提供更多信息和依据。 小结 谢 谢！ * * * Notes: * * Finally, IVUS is performed using a catheter (3.2-3.5 French): FFR is performed using a pressure sensor mounted on a hydrophilic guidewire. The small size (0.014”) of PressureWire? allows access to smaller vessels and eliminates obstruction due to equipment. *) 3.2 French = outer diameter 0.042 inches. * How can one absolute value (IVUS CSA 4.0 mm2) be applicable in both the small vessels of this tiny lady and in the large vessels of this big man? * This 70-year-old woman’s left coronary artery shows suspicious disease by coronary angiography. IVUS shows a significant stenosis in the distal part of the LAD (CSA 3.1 mm2). Based on this morphological information alone, many interventionists would stent the LAD. However, when a pressure pullback measurement is performed during maximum hyperemia, the FFR result is 0.87 – well above the cutoff for a significant stenosis. According to FFR, despite the way the lesions look, the patient’s myocardium is still receiving the blood flow that it needs. In daily practice, factional flow reserve (FFR) and intravascular ultrasound (IVUS) will not always agree. Interventionists who understand that FFR and IVUS do not provide the same information know that FFR is the correct way to assess lesion severity. * * It this stage it is important to remind again that CFR accounts for both the resistance due to the stenosis and the resistance related to the myocardium while FFRmyo mainly accounts fo