The IMPACT Study (Influence of Sensor-Equipped Microcatheters on Coronary Hemodynamics and the Accuracy of Physiological Indices of Functional Stenosis Severity)

Abstract

Introduction of the Navvus microcatheter leads to clinically relevant stenosis severity overestimation in intermediate stenosis.

A head‐to‐head comparison of three coronary fractional flow reserve measurement technologies: The fractional flow reserve‐device study

“…The higher rates of drift with the optic‐sensor‐equipped C guidewire in our study support the hypothesis that it is the microcatheter technology and not the optic‐sensor, which explains the lower rates of drift. However, concordant with other studies the microcatheter had higher rates of crossing failure, which is awaited to be improved by near‐future improvement of its profile, and its second use over the C wire was associated with reduced intra‐test concordance, suggesting a potential sensor or microcatheter degradation after an initial use.…”

“…Interestingly, while the simultaneous measurements of FFR were significantly lower with the C guidewire as compared to those of the N catheter, in clinically relevant conditions, FFR values were similar between the two systems. The presence of the N catheter increases coronary resistance to flow, as previously reported for the P guidewire leading to lower FFR values measured by the C guidewire. In clinically relevant conditions, the two optic sensor technologies provide similar results but different from those provided by the piezo‐electric sensor‐equipped guidewire.…”

“…However, its 0.022 in. diameter reduces its crossability profile limiting its use in angulated, tortuous or calcified lesions and increases coronary resistance to flow leading to a potential overestimation of the hemodynamic impact of coronary stenoses …”

“…However, they may not be as performant as specifically designed PCI guidewires and operators need to retrieve and re‐cross lesions by the guidewire for the assessment of pressure drift, further measurements and PCI. The microcatheter technology allows the use of standard PCI guidewires but is associated with lower crossability profile and its in situ presence may increase resistance to coronary flow and lead to the overestimation of the hemodynamic impact of coronary stenoses . The advantages and pitfalls of piezo‐electric vs optic sensor technologies are unclear.…”

Fractional flow reserve guided percutaneous coronary intervention optimization directed by high-definition intravascular ultrasound versus standard of care: Rationale and study design of the prospective randomized FFR-REACT trial

“…Additionally, pre PCI FFR assessment using the Navvus microcatheter has proven to significantly overestimated the stenosis severity as compared to pressure wire based FFR measurements. 23,24 However, this difference was mainly driven by a larger delta in vessels with a small minimal luminal area pre procedure. It is currently unknown if post PCI FFR assessment with the latter two methods will exemplify the same variance and direct extrapolation of the current study to pressure wire based post PCI FFR assessment and optimization is therefore not possible.…”