The impact of coronary chronic total occlusion percutaneous coronary intervention upon donor vessel fractional flow reserve and instantaneous wave‐free ratio: Implications for physiology‐guided PCI in patients with CTO

Mohdnazri, Shah; Karamasis, Grigoris V.; Al-Janabi, Firas; Cook, Christopher; Hampton‐Till, James; Zhang, Jufen; Al‐Lamee, Rasha; Dungu, Jason; Gedela, Srinubabu; Kelly, Paul A.; Davies, Justin E.; Davies, John R.

doi:10.1002/ccd.27587

Cited by 20 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fourth, the follow‐up period was only about 8 months. While it is unclear whether this was long enough to evaluate the electrophysiological changes after PCI, Mohdnazri et al . reported that both FFR and the instantaneous wave‐free ratio were significantly increased in the territory of the predominant donor vessel after a follow‐up period of 4 months.…”

Section: Limitationsmentioning

confidence: 99%

Impact of recanalization of chronic total occlusion on left ventricular electrical remodeling

Yamashita

Igawa

Ono

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

BackgroundSuccessful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is associated with reduction of cardiac mortality, as well as reducing fatal ventricular arrhythmias. The aim of this study was to evaluate the effect of recanalization of CTO on endocardial left ventricular voltages by paired electrophysiological studies.MethodsSixteen consecutive patients who underwent PCI for de novo CTO lesions were included. High‐density mapping was performed during sinus rhythm before and 8 months after PCI. According to the amplitude of bipolar electrograms, the left ventricular endocardium was classified into a preserved normal voltage (>1.5 mV), border zone (0.5–1.5 mV), and dense scar areas (<0.5 mV).ResultsThe border zone area had a significant positive correlation with CTO length, as well as a significant negative correlation observed in the preserved voltage region. In the successful PCI patient, the median dense scar area did not change significantly (reported as [median difference: 95% confidence interval]) between baseline and after PCI (0.1 cm2: –2.8 to 2.9). However, the area of the border zone decreased (–10.5 cm2: –16.8 to –4.1) and the preserved voltage area increased significantly (19.2 cm2: 7.7–30.6). In addition, successful PCI was related to slight, but significant, increase in the amplitude of unipolar and bipolar voltage (1.55 mV: 0.88–3.33, 0.23 mV: 0.08–0.36).ConclusionsRecanalization of CTO may promote reverse electrical remodeling in the border zone of the left ventricle, without affecting the dense scar tissue.

show abstract

Section: Limitationsmentioning

confidence: 99%

Impact of recanalization of chronic total occlusion on left ventricular electrical remodeling

Yamashita

Igawa

Ono

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…The reduction of the perfused area of the measured artery decreases coronary blood flow volume. The recanalization of a chronic total occlusion lesion leads to an increase of the FFR value of the predominant collateral donor vessel associated with a reduction in perfusion territory and coronary flow [4][5][6][7]. Coronary artery bypass grafting (CABG) and bypass graft occlusion both change the blood flow of the native coronary arteries.…”

Section: Introductionmentioning

confidence: 99%

A case report of myocardial ischemia improvement despite early bypass graft occlusion: Efficiency of physiological reassessment

Nakayama

Takahashi

Horinaka

et al. 2020

Journal of Cardiology Cases

View full text Add to dashboard Cite

Patients with functional ischemia often do not complain of chest symptoms even in early occlusion after coronary artery bypass grafting (CABG). The clinical evidence indicating the necessity of revascularization for these patients is unclear. A 70-year-old man who underwent 3 stent implant procedures to treat repeated in-stent restenosis to the left anterior descending artery (LAD) felt effort-related chest pain. Coronary angiography revealed that the patient's jailed diagonal had severe stenosis with delay and the LAD had intermediate stenosis. The instantaneous wave-free ratio (iFR) value of the LAD equalled 0.75. The patient underwent sequential CABG, where the left internal mammary artery (LIMA) to the LAD and diagonal artery grafts were performed. Although his effort-related chest pain disappeared, coronary and bypass angiography did not show flow competition in the diagonal branch and early occlusion in the LIMA to LAD graft was confirmed. The physiological assessment of the LAD did not reveal myocardial ischemia (iFR = 0.89 and fractional flow reserve = 0.87). This case highlights the importance of physiological assessment to detect cases of early graft occlusion. Although the LAD was not perfused from the CABG, the iFR value improved dramatically and pharmacological therapy without revascularization was successful for this patient.

show abstract

“…This is supported by data to show that upon successful PCI of the CTO, the donor vessel FFR and iFR show an immediate and sustained increase. 39,40…”

Section: Chronic Total Occlusionsmentioning

confidence: 99%

How to select patients requiring coronary revascularisation using coronary physiology

Modi

Perera

2021

JRSM Cardiovascular Disease

View full text Add to dashboard Cite

The coronary angiogram is an indicator of flow limiting coronary artery disease but coronary physiology at the time of angiography is vital in assessing the true functional significance of coronary artery disease. With advances in guidewire technology and the greater use of physiology within the catheter laboratory, there is now a slow evolution of physiological indices in being able to reliably assess the functional significance of individual lesions and also the adequacy of revascularization in a growing range of clinical scenarios. As co-registration of physiology with the angiogram and intravascular imaging will become easier, we will find ourselves increasingly in an era of ‘Precision PCI’.

show abstract

The impact of coronary chronic total occlusion percutaneous coronary intervention upon donor vessel fractional flow reserve and instantaneous wave‐free ratio: Implications for physiology‐guided PCI in patients with CTO

Abstract: Successful recanalization of an RCA CTO resulted in a modest but statistically significant increase in the predominant donor vessel immediately post CTO PCI in the case of iFR and at 4-month follow-up for FFR and iFR compared to pre-PCI with a concomitant reduction in collateral function.

Cited by 20 publications

References 19 publications

Impact of recanalization of chronic total occlusion on left ventricular electrical remodeling

Impact of recanalization of chronic total occlusion on left ventricular electrical remodeling

A case report of myocardial ischemia improvement despite early bypass graft occlusion: Efficiency of physiological reassessment

How to select patients requiring coronary revascularisation using coronary physiology

Contact Info

Product

Resources

About