Fractional flow reserve for a mild stenosis on the donor artery to chronic total occlusion
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CASE REPORT
Fractional flow reserve for a mild stenosis on the donor artery to chronic total occlusion Harue Sasai • Kenichi Sakakura • Koichi Yuri • Hiroshi Wada • Kenshiro Arao • Hiroshi Funayama • Yoshitaka Sugawara • Atsushi Yamaguchi • Hideo Adachi • Shin-ichi Momomura • Junya Ako
Received: 17 June 2012 / Accepted: 5 October 2012 / Published online: 18 October 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract Fractional flow reserve (FFR) is considered as the gold standard for physiological assessment of coronary artery stenosis. However, it may be difficult to interpret FFR for the stenosis of the donor artery of chronic total occlusion (CTO), because revascularization of CTO may improve FFR of the donor artery. We present a case of 32-year-old male who had a CTO in right coronary artery (RCA), 90 % stenoses in left circumflex artery (LCx) and a mild stenosis in the middle segment of left anterior descending artery (LAD). FFR for the mild stenosis in LAD showed significant value (0.72). However LAD was the donor artery to CTO of RCA, revascularization to RCA was expected to improve FFR for LAD. As the patient had chronic granulocytic leukemia and the difficulty in continuing dual antiplatelet therapy, we selected coronary artery bypass grafting (CABG) to RCA and LCx, and we decided not to perform anastomosis to LAD. Although each graft was patent and collateral flow from LAD to RCA disappeared after CABG, FFR for LAD was still 0.72. Careful consideration should be given when interpreting FFR for the donor artery to a CTO lesion. When CABG is selected, it may be a practical approach to revascularize not only CTO but also FFR positive mild stenosis simultaneously, even though it appears angiographically mild stenosis.
Keywords Fractional flow reserve Donor artery Intermediate stenosis
Introduction Fractional flow reserve (FFR) is considered as the gold standard for physiological assessment of coronary artery stenosis. FFR is useful for patients with intermediate single-vessel disease, left main stenosis, complex bifurcation lesions or multi-vessel coronary artery disease [1]. However, it may be difficult to interpret FFR for the stenosis of the donor artery of chronic total occlusion (CTO), because revascularization of CTO may improve FFR of the stenosis on the donor artery [2, 3]. We present a case who had a mild stenosis in the middle segment of left anterior descending artery (LAD). FFR for the angiographically mild stenosis in LAD showed significant value (0.72). However, LAD was the donor artery to CTO of right coronary artery (RCA). As revascularization to RCA might improve FFR for LAD, the necessity of revascularization to LAD was discussed.
Case report
H. Sasai K. Sakakura (&) H. Wada K. Arao H. Funayama Y. Sugawara S. Momomura J. Ako Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 847-1, Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, Japan e-mail: [email protected] K. Yuri A. Yamaguchi H. Ada
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