FFR Guided Treatment Of Significant Bifurcation Lesions

   

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During coronary revascularisation involving a main vessel and a side branch, it is unclear whether ballooning of the side branch is a prerequisite for long term clinical success. Coronary physiology techniques such as Fractional Flow Reserve (FFR) provide a unique way to scientifically quantify whether a side-branch may need revascularisation following treatment of the main vessel.

Frequently it is difficult to rewire a side branch which involves passing a catheter through stents in the main vessel. This can be difficult with a conventional pressure wire. Newver systems such as the Acist Navvus Rapid Exchange FFR microcatheter runs over the regular work horse wire chosen by the operator. This means that it is possible to measure FFR more easily in heavily diseased and anatomically challenging vessels. Learn more about FFR from one of our online or London courses.

  1. Identify and grade significant coronary bifurcation disease
  2. Demonstrate passage of Acist Navvus through the coronary stent struts
  3. Implement FFR technology in bifurcation disease
  4. Select proper stent strategy: provisional or 2-stent technique based on FFR result
  5. Treat bifurcation side-branch when appropriate
  6. Measure post-PCI improvement
  7. Summarise role of physiology in coronary artery revascularisation
This case is to inform and educate interventional cardiologists on:
  • Strategy selection to approach significant true bifurcation lesions
  • Implementation of FFR assessment in bifurcation lesions
  • Implementation of FFR in side-branch assessment after provisional stenting
  • Use of microcatheter based FFR technology
  • Interventional cardiologists
  • Interventional cardiology fellows
  • Cardiologists taking care of patients with coronary artery disease
  • Catheterisation laboratory nursing and technical staff and healthcare professionals

Dr. Nicolas M. Van Mieghem obtained his medical degree and cardiology degree at the Catholic University of Leuven, Belgium. After subsequent Fellowships in interventional cardiology in Ziekenhuis Oost-Limburg Genk, Belgium, Lenox Hill Hospital, New York, USA and Erasmus Medical Center, Rotterdam, the Netherlands, he joined the department of interventional cardiology in the Thoraxcenter, Erasmus MC as a senior staff member in February 2010. He is involved in the percutaneous coronary interventions and structural heart program. He obtained the degree of PhD based upon his research in transcatheter valve therapies. So far he has published and co-authored approximately 130 scientific papers in peer-reviewed journals. Dr. Van Mieghem is principle investigator and steering committee member in multiple ongoing international trials evaluating various coronary and transcatheter valve technologies. He is a Fellow of the European Society of Cardiology (FESC) and is currently Medical Director of the department of Interventional cardiology in the Thoraxcenter, Erasmus MC, Rotterdam.

  • Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2014;35:2541–2619.
  • Pijls NH, Tanaka N, Fearon WF. Functional assessment of coronary stenosis: can we live without it? Eur. Heart J. 2013;34:1335-1344.
  • Diletti R, Van Mieghem NM, Valgimigli M, et al. Rapid exchange ultra-thin microcatheter using fibre-optic sensing technology for measurement of intracoronary fractional flow reserve. EuroIntervention. 2015;11:428-432.