Easy to Use , Physical Bifurcation PCI, No drift
- Allows to perform complex procedures
- Evaluation of hyperemic and resting indices (dPR)
- Absence of drift
- 50-year-old man
- Risk factors: Dyslipidemia
- Presented with CCS Class II angina
- Coronary CT angiography: significant stenosis proximal LAD (Figure 1)
- Echocardiogram: normal ejection fraction
Left coronary system (Figure 2):
- LM: aneurismal lesion and fistula with pulmonary artery
- LAD: significant lesion of the proximal and mid segment (Medina 1-1-0).
- LCx: no relevant stenosis.
Pressure Measurements in Left Anterior Descending
- OpSens diastolic Pressure Ratio (dPR) was measured in both LAD (dPR 0.39) and diagonal branch (dPR 0.33), showing a significant stenosis, despite angiography showed a not significant stenosis of the diagonal branch.
PCI of the prox/mid LAD was performed using a 7Fr Guiding over a workhorse wire, while a provisional OptoWire™ guidewire was positioned in the diagonal branch.
- 2.5 x 30 mm semi-compliant balloon over the OptoWire™ to protect the diagonal branch
- 3.0 x 32 mm everolimus bioabsorbable polymer stent was implanted in the prox/mid LAD.
Post-PCI Pressure Measurements
- Evaluate the severity of the lesion
- Perform a provisional stenting of the bifurcation
- Compare the angiographic result to the physiological assessment post-PCI
- Ciccarelli G. et al, Angiography Versus Hemodynamics to Predict the Natural History of Coronary Stenoses: a FAME 2 Substudy, Circulation, 2018
- Tonino PA. et al, Fractional flow reserve versus angiography for guiding percutaneous coronary intervention, New England Journal of Medicine, 2009
- De Bruyne B, et al, Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease, New England Journal of Medicine, 2012
- Davies JE et al, Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI, New England Journal of Medicine, 2017
- Götberg M et al, Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI, New England Journal of Medicine, 2017
- Marcel van’t Veer et al, Comparison of Different Diastolic Resting Indexes to iFR: Are They All Equal?, Journal of American College of Cardiology. 2017