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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.


Nicolas M Van Mieghem

Nicolas M Van Mieghem

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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

Key Learning Objectives

  • 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

Target Audience

  • Interventional cardiologists
  • Interventional cardiology fellows
  • Cardiologists taking care of patients with coronary artery disease
  • Catheterisation laboratory nursing and technical staff and healthcare professionals

Faculty Biographies

Nicolas M Van Mieghem

Nicolas M Van Mieghem

Prof Nicolas Maria Van Mieghem is an Interventional cardiologist at Thoraxcenter, Erasmus MC, Rotterdam, NL decided to pursue a career that would help others. “I enjoy the feeling of being able to help someone or do something important for them". His father was a general cardiologist and one of his biggest influences early in his career.

Prof Van Mieghem initially intended to train as a cardiac surgeon but decided to specialise in interventional cardiology instead, following advice from a mentor. This decision was cemented when he read the first-in-human case report of transcatheter aortic valve implantation (TAVI) in Circulation by Alain Cribier in 2002. Prof Van Mieghem believes that great cardiologist genuinely cares for their patients. He names Gary Roubin, Dr Manu Malbrain and Professor Patrick Serruys among his mentors. 

His current research focuses on cerebral embolic protection during TAVI and the search for improved large bore closure devices. He works actively in expanding TAVI indications, most notably TAVI as a means to further unload the left ventricle in heart failure patients with moderate aortic stenosis (the TAVR UNLOAD trial). Prof Van Mieghem is also involved in the development and dispersion of mechanical circulatory support (MCS) devices as well as transcatheter mitral and tricuspid repair techniques. In terms of imaging and preprocedural planning, his research has covered computed tomography (CT)-derived 3D modelling and printing.

As well as his involvement in percutaneous coronary interventions and structural heart programs, he has published and co-authored over 350 scientific papers in peer-reviewed journals. Professor Van Mieghem is a principal 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 at the Thorax Centre.

 Prof Van Mieghem is on the ICR3 Editorial Board.


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Key References

1. 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.

2. Pijls NH, Tanaka N, Fearon WF. Functional assessment of coronary stenosis: can we live without it? Eur. Heart J. 2013;34:1335-1344.

3. 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.