ffr-标准版fameii.ppt

* * * * * * * * * * * Intermediate stenosis in one or more coronary arteries, even bypass grafts. (Evidence of ischemia?) Serial lesions (Culprit? Cumulative effect?) Diffuse disease (Focal treatable region?) Ostial or distal left main and ostial right lesions (Significant?) Sidebranch lesions (Significant?) Multivessel Disease (Culprit?) In-stent restenosis(Conservative management or revascularization?) Prior MI(A surrogate for non-invasive testing?) FFR is not applicable/validated in: Severe left ventricular hypertrophy, STEMI/transmural myocardial infarction 5 days. * It could be very difficult to predict the severity of an intermediate stenosis (40-60%) just by eyeballing an fluoroscopic image. Does this RCA stenosis look significant? Should it be treated?According to the FFR measurement this lesion is NOT significant and is NOT the lesion that causes the patients chest pain/ischemia. Reference: “How good are experienced cardiologists at predicting the hemodynamic severity of coronary stenoses when taking FFR as the golden standard”, Brueren et al, The international Journal of Cardiovascular Imaging; 2002: 18; 73-76 * In arteries with serial stenoses it is helpful to perform a “pullback” over the stenoses to find the culprit lesion(-s) causing the patient’s ischemia. In this case the vessel has serial lesions that look quite severe. By performing a pullback you find out that there is no pressure drop at the 2nd or 3rd stenosis. The 1st and 4th are the culprit lesions. * In a vessel with diffuse disease the pullback shows that there is no culprit lesion that is the cause of the patients symptoms. PressureWire? curve is linear. * In the case of a main stem stenosis, it can be helpful to measure pressure. Physiological assessment of the left main could mean the difference between Coronary Artery Bypass (CABG), PCI only, or no treatment required at all. * The conclusion of the study by Koo was that most side branch lesions suspect after s