Functional assessment of tandem coronary artery stenosis by intracoronary optical coherence tomography-derived virtual fractional flow reserve: a case series
Functional assessment of tandem coronary artery stenosis by intracoronary optical coherence tomography-derived virtual fractional flow reserve: a case series
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DOI：
10.1093/ehjcr/ytz087
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发表时间：
2019-05
期刊：
影响因子：
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通讯作者：
Y. Okuya;Fumiyasu Seike;K. Yoneda;Takefumi Takahashi;K. Kishi;Y. Hiasa
中科院分区：
文献类型：
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作者：
Y. Okuya;Fumiyasu Seike;K. Yoneda;Takefumi Takahashi;K. Kishi;Y. Hiasa
摘要背景光学相干断层扫描（OCT）衍生的血流储备分数（FFR）-可以使用流体动力学计算-与基于导线的FFR表现出良好的相关性。然而，OCT衍生的FFR在串联病变评估中的适用性目前尚不清楚。病例总结我们报告了2例左前降支（LAD）中段串联病变，可通过OCT衍生的FFR进行准确评估。第一例患者在LAD远端部位接受了基于导丝的FFR，显示值为0.66。计算OCT衍生的FFR，得出的值为0.64。在近端病变不存在狭窄的情况下，OCT衍生的FFR计算为0.79，与近端病变支架植入后获得的基于导丝的FFR相同。因此，在远端病变处进行了额外的支架植入术。第2例患者在LAD远端部位接受了基于导丝的FFR，显示值为0.76，与OCT导出的FFR值相同。考虑到近端病变无狭窄，OCT衍生的FFR估计为0.88。在近端病变中植入冠状动脉支架后，基于导丝的FFR值为0.90。因此，推迟了对远端病变的额外干预。讨论所描述的报告是使用OCT对串联病变进行生理评估的前两个病例。OCT衍生的FFR可能能够估计串联病变患者中基于导丝的FFR和每个单独病变的严重程度。
Abstract Background Optical coherence tomography (OCT)-derived fractional flow reserve (FFR)—which may be calculated using fluid dynamics—demonstrated an excellent correlation with the wire-based FFR. However, the applicability of the OCT-derived FFR in the assessment of tandem lesions is currently unclear. Case summary We present two cases of tandem lesions in the mid segment of the left anterior descending (LAD) artery which could have assessed accurately by OCT-derived FFR. The first patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.66. The OCT-derived FFR was calculated, yielding a value of 0.64. In the absence of stenosis at the proximal lesion, the OCT-derived FFR was calculated as 0.79, which was as same as the wire-based FFR obtained after stenting to the proximal lesion. Thus, additional stenting was performed at the distal lesion. The second patient underwent wire-based FFR at the far distal site of LAD, showed a value of 0.76 which was as same vale as OCT-derived FFR. Considering the absence of stenosis in the proximal lesion, the OCT-derived FFR was estimated as 0.88. After coronary stenting in the proximal lesion, the wire-based FFR yielded a value of 0.90. Therefore, additional intervention to the distal lesion was deferred. Discussion The described reports are the first two cases which performed physiological assessment using OCT in tandem lesions. The OCT-derived FFR might be able to estimate the wire-based FFR and the severity of each individual lesion in patients with tandem lesions.