ffr et bifurcation
DESCRIPTION
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) - PowerPoint PPT PresentationTRANSCRIPT
FFR et bifurcation
FFR et MB avant ATL
MBSB
?
1. Intermediate stenoses (Pijls et al. New Engl J Med 1996) (Pijls et al. JACC 2010)
2. Post-myocardial setting (De Bruyne et al Circulation 2001)(Ntalianis et al. JACCInterv 2010)
3. Multivessel Disease (Tonino et al. New Engl J Med 2009)
4. Left main stenosis (Hamilos, Muller et al. Circulation 2009)
5. Proximal LAD stenosis (Muller et al. JACCInterv 2011)
The Value of FFR in terms of Clinical Outcome
Has Been Validated in patients with
FFR et MB avant ATL
MBSB
Oui
FFR et SB avant ATL
MBSB
?
Mach band in bifurcation
http://en.wikipedia.org/wiki/Lateral_inhibition
"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."
Lateral Inhibition (or Mach band visual effect)
Mach band in bifurcation
Mach band in bifurcation
FFR et SB avant ATL
FFR overestimates the severity1.
2. Jailing of a pressure wire between the stent and the vessel wall is not recommended
Anatomical changes after MB stenting: carina shift, stent struts3.
FFR et SB avant ATL
MBSB
Peu utile
FFR et MB après ATL
MBSB
?
FFR et MB après ATL
Pijls, Circulation 2002 Samady, JACCinterv 2009
Pas d’interet
FFR et SB après ATL
MBSB
?
FFR et SB après ATL
1. FFR-guided provisional SB intervention strategy is feasible and effective
2. Functional status of jailed SB lesions after DES implantation does not change significantly during follow-up
Koo, European Heart Journal (2008)
FFR Basics for bifurcation
Bifurcation
MB
Before PCI
YES
After PCI
(YES)
SB
Before PCI
(YES and NO)
After PCI
YES(subset of lesions)
FFR
Anatomically significant stenosis is frequently functionally insignificant
Among side branch lesions > 75% stenosis after main vessel stenting, only 27% were functionally significant.
(Pd/Pa)
FFR PdPa
=
Koo BK, J Am Coll Cardiol 2005
FFR can tell what you have really done……
Before PCI After MB stenting After kissing balloon
MMain prox. first
AMain Accross side first
DDistal first
SSide branch first
Extended V
Skirt
PM stenting
MB stenting across SB
MB stenting + kissing
MB stenting + SB balloon
ElectiveT
stentingInternalcrush
Culotte TAP
DM stenting
ProvisionalSKS
Vstenting
SKS
Trouser legsand seat
SB ostial stenting
SB minicrush
SB crush
Syst. T Stenting
Minicrush Crush
Afterballoon
2 stents
3 stents
1st stent
Skirt +
DMSkirt + SB
Y. Louvard, CCI 2008;71(2):175-83.
Provisional SB Stenting is
The Gold Standard !