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FFR et bifurcation

FFR et bifurcation. FFR et MB avant ATL. SB. MB. ?. The Value of FFR in terms of Clinical Outcome Has Been Validated in patients with. Intermediate stenoses ( Pijls et al. New Engl J Med 1996) (Pijls et al. JACC 2010) Post-myocardial setting (De Bruyne et al Circulation 2001)

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FFR et bifurcation

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  1. FFR et bifurcation

  2. FFR et MB avant ATL SB MB ?

  3. The Value of FFR in terms of Clinical Outcome Has Been Validated in patients with • Intermediate stenoses(Pijls et al. New Engl J Med 1996) • (Pijls et al. JACC 2010) • Post-myocardial setting (De Bruyne et al Circulation 2001) • (Ntalianis et al. JACCInterv 2010) • Multivessel Disease (Tonino et al. New Engl J Med 2009) • Left main stenosis(Hamilos, Muller et al. Circulation 2009) • Proximal LAD stenosis(Muller et al. JACCInterv 2011)

  4. FFR et MB avant ATL SB MB Oui

  5. FFR et SB avant ATL SB MB ?

  6. Mach band in bifurcation

  7. Lateral Inhibition (or Mach band visual effect) "Mach bands are an optical illusion consisting of an image of two wide bands, one light and one dark, separated by a narrow strip with a light-to-dark gradient. The human eye perceives two narrow bands of different brightnesses either side of the gradient that are not present in the original image." http://en.wikipedia.org/wiki/Lateral_inhibition

  8. Mach band in bifurcation

  9. Mach band in bifurcation

  10. FFR et SB avant ATL 1. FFR overestimates the severity Jailing of a pressure wirebetween the stent and the vesselwallis not recommended 2. Anatomical changes after MB stenting: carina shift, stent struts 3.

  11. FFR et SB avant ATL SB MB Peu utile

  12. FFR et MB après ATL SB MB ?

  13. FFR et MB après ATL Pas d’interet Pijls, Circulation 2002 Samady, JACCinterv 2009

  14. FFR et SB après ATL SB MB ?

  15. FFR et SB après ATL FFR-guided provisional SB intervention strategy is feasible and effective 2. Functionalstatus of jailed SB lesionsafter DES implantation does not change significantlyduringfollow-up Koo, EuropeanHeart Journal (2008)

  16. FFR Basics for bifurcation FFR

  17. Anatomically significant stenosis is frequently functionally insignificant • Among side branch lesions > 75% stenosis after main vessel stenting, only 27% were functionally significant. FFR P d = P a (Pd/Pa) Koo BK, J Am CollCardiol 2005

  18. FFR can tell what you have really done…… Before PCI After MB stenting After kissing balloon

  19. M Main prox. first A Main Accross side first D Distal first S Side branch first 1st stent PM stenting MB stenting across SB DM stenting SB ostial stenting Provisional SKS After balloon Skirt MB stenting + SB balloon MB stenting + kissing SB minicrush SB crush 2 stents Elective T stenting Internal crush Culotte TAP V stenting SKS Syst. T Stenting Minicrush Crush Skirt + DM Skirt + SB 3 stents Extended V Trouser legs and seat Provisional SB Stenting is The Gold Standard ! Y. Louvard, CCI 2008;71(2):175-83.

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