Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

Jasti, Venu; Ivan, Eugen; Yalamanchili, Venkata; Wongpraparut, Nattawut; Leesar, Massoud A.

doi:10.1161/01.cir.0000146338.62813.e7

Cited by 371 publications

(174 citation statements)

References 25 publications

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“…В отличие от ФРК, ВСУЗИ -диа-гностический метод визуализации и не позволяет оценить функциональную тяжесть стеноза. Было показано, что ранее принятые пороговые значения 3,5-4,0 мм 2 для стеноза крупной эпикардиальной артерии и 6,0 мм 2 для стеноза ствола ЛКА [403] ненадежные и плохо коррелируют с ФРК, при этом результаты несколько лучше, если абсолютные показа-тели ВСУЗИ корректируются с учетом размеров рефе-рентного сосуда. Как только показание к вмешатель-ству определено, необходимо получить дополнитель-ную информацию, и в этом отношении ВСУЗИ намного информативнее ФРК, поскольку предостав-ляет анатомическую характеристику поражения, с раз-мерами сосуда, составом бляшки, а также позволяет контролировать раскрытие стента и прилегание балок к стенке сосуда.…”

Section: Iib B 373-375unclassified

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Montalescot

Sechtem²,

Achenbach³

et al. 2014

Russ J Cardiol

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Section: Iib B 373-375unclassified

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Montalescot

Sechtem²,

Achenbach³

et al. 2014

Russ J Cardiol

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“…It is noteworthy that, in the pioneering study by Fassa et al 20 , a LMCA lesion with MLA < 7.5 mm 2 was considered severe. On the other hand, 10 (15.5%) of the patients in the present study had MLA between 6.0 and 7.5 mm 2 , and two of them were kept under clinical treatment with no occurrence of degree of myocardial ischemia 23 . Nonetheless, the appropriate MLA cutoff is yet to be defined, given that, depending on the study in question, the MLA varied from 5.0 to 8.0 mm 2 20,23 .…”

mentioning

confidence: 51%

Utilidade do ultra-som intracoronariano na decisão do tratamento de pacientes com lesões duvidosas no tronco da coronária esquerda

Vaz

Abizaid

et al. 2006

Arq. Bras. Cardiol.

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Objective: To evaluate the safety and efficacy of surgical treatment approach vs. conservative approach in patients with ambiguous lesions in the left main coronary artery (LMCA), based on intracoronary ultrasound (ICUS) findings. Methods:Sixty-six consecutive patients with angiographically ambiguous lesions were included and submitted to ICUS assessment. They were divided in two groups, according to the ICUS findings. Group I was maintained under clinical treatment [minimal lumen area (MLA) ≥ 6.0 mm 2 and/or minimal lumen diameter (MLD) ≥ 2.5 mm] and Group II was submitted to revascularization (MLA < 6.0 mm 2 and/or MLD < 2.5 mm). The occurrence of major cardiac events (death, acute myocardial infarction and/or revascularization of the target lesion) was assessed during follow-up.Results: Forty-one (62%) patients were allocated in Group I and 25 (38%) in Group II. Mean follow-up was 42.1 months. The coronary angiography did not differentiate the two groups regarding lesion severity (MLD 1.98 mm in Group I vs. 1.72 mm in Group II;p = 0.75) in opposition to ICUS (MLD 3.41 mm in Group I vs. 2.01 mm in Group II;p < 0.001). There was no death or myocardial infarction in Group I. The survival rate free of major cardiac events was 95% in Group I vs. 87.5% in Group II (p=ns). Conclusion:Treatment decision-making of patients with ambiguous lesions in the LMCA guided by ICUS findings showed to be safe and effective. . Referring patients with no significant LMCA lesions for coronary revascularization could lead, however, to the inappropriate use of available grafts, as well as to the premature occlusion of grafts or even of the native arteries. Angiography is considered the standard method of reference and it is most often utilized in the invasive diagnosis of coronary disease. Nevertheless, it can present limitations in some situations, such as when assessing the degree of severity of LMCA lesions. Furthermore, necropsy and intracoronary ultrasound (ICUS) studies have demonstrated several situations in which the LMCA presented significant lesions whereas, frequently, the angiography did not disclose important lesions 5,6 . ICUS is an invasive method that allows the identification of the real dimensions of the vessel and the components of the atherosclerotic plaque and the precise measurement of the arterial lumen, being a more sensitive method than angiography to assess the initial phase of atherosclerosis 7,8 . Several studies have demonstrated the usefulness of ICUS in the identification of LMCA lesions [9][10][11] . The aim of this study is to assess the safety and efficacy of the surgical vs. conservative treatment in patients with ambiguous lesions in the left main coronary artery (LMCA), based on intracoronary ultrasound (ICUS) findings. MethodsPatients -From December 1999 to June 2004, 66 consecutive patients who presented angiographically ambiguous LMCA lesions (moderate lesions, exclusively aortic-ostial lesions, short LMCA lesions, among others) and had been referred for ICUS assessment at the Invasive Cardiolo...

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“…An FFR of >0.75 or >0.80 correlates with excellent long-term outcomes if PCI is deferred [40,43,[51][52][53]. FFR has also been shown to predict physiologic significance of left main coronary lesions, although the data are not as robust [54][55][56].…”

Section: Methods Of Determining Significance Of Coronary Diseasementioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

Cited by 371 publications

References 25 publications

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

Utilidade do ultra-som intracoronariano na decisão do tratamento de pacientes com lesões duvidosas no tronco da coronária esquerda

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

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