Potential influence of invisible coronary collateral circulation on fractional flow reserve of donor artery in the prese
- PDF / 643,130 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 40 Downloads / 198 Views
CASE REPORT
Potential influence of invisible coronary collateral circulation on fractional flow reserve of donor artery in the presence of severe stenosis of receiving artery Hiroto Tamaru • Kenichi Fujii • Masashi Fukunaga • Takahiro Imanaka • Kojiro Miki • Daizo Kawasaki • Motomaru Masutani • Mitsumasa Ohyanagi • Tohru Masuyama
Received: 23 January 2014 / Accepted: 26 May 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract We reported a case of 78-year-old male who had a severe stenosis in the right coronary artery (RCA) and an intermediate stenosis in the left anterior descending artery (LAD) without visible collateral flow to the RCA on angiogram. Fractional flow reserve (FFR) in the LAD lesion, which revealed significant value as 0.70, increased to 0.78 after revascularization of the RCA lesion. The FFR in an intermediate stenosis should be performed after PCI for severe stenosis in the other coronary arteries. Otherwise, the severity of the stenosis could be overestimated due to the presence of invisible collateral circulation.
ischemia with an accuracy of more than 90 % [3]. In addition, myocardial FFR takes into account the contribution of collateral blood flow to hyperemic myocardial flow, because the distal coronary pressure is determined by aortic pressure and by the extent of collateral circulation in case of isolated epicardial stenosis [4]. We describe a case showing that the hemodynamic significance of intermediate stenosis in the left anterior descending artery (LAD) was overestimated with FFR because of the presence of angiographically invisible functional collateral to the right coronary artery (RCA) that has a severe stenosis.
Keywords Fractional flow reserve Coronary artery disease Collateral circulation Intervention
Case report
Introduction Fractional flow reserve (FFR), a ratio of the maximum myocardial blood flow in the presence of the coronary stenosis to the absence of the coronary stenosis, has certain advantages over other techniques to evaluate narrowed coronary arteries physiologically in the cardiac catheterization laboratory [1, 2]. Previous study indicated that an FFR value of less than 0.75 normally indicates inducible ischemia, and that an FFR value greater than 0.80 excludes H. Tamaru K. Fujii (&) M. Fukunaga T. Imanaka K. Miki D. Kawasaki T. Masuyama Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501, Japan e-mail: [email protected] M. Masutani M. Ohyanagi Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
A 78-year-old male was admitted to our hospital because of chest pain on exertion 4 weeks before admission. He had been hypertensive for 30 years. His history also included diabetes mellitus, dyslipidemia and past smoking. When he was 75 years old, a drug-eluting stent was implanted in the proximal LAD for angina pectoris on exertion. Because of new ischemia at left ventricular inferior wall on exercise stress myocardial scintigram, c
Data Loading...
