Clinical applications of fractional flow reserve in bifurcation lesions

Abstract

Percutaneous coronary intervention (PCI) for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the functional significance of bifurcation lesions. The fractional flow reserve (FFR) is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.

State of the art paper Comprehensive assessment of coronary fractional flow reserve

“…The FFR is an accurate and lesion-specific index to indicate whether a stenosis is responsible for ischemia [ 9 ]. It has been well established that FFR is a reliable and feasible measurement tool of CAD, including angiographic intermediate stenosis, multi-vessel disease, left main coronary artery stenosis, and bifurcation lesions, and of significant benefit in guiding percutaneous coronary intervention (PCI) [ 5 , 6 , 10 – 13 ]. Thus, current guidelines recommend FFR as level of evidence ‘A’ when the ischemic potential for specific lesions is controversial [ 14 ].…”