Case report of FFR for bifurcation

Nanjing first hospitalNanjing heart centerYefei chenshaoliang

Evidence of FFR guided PCI • For single lesion: DEFER study;• For multivessel disease: FAME study;• For bifurcation lesions using 1-stent technique: Koo

BK, et al. Eur Heart J 2008;• For bifurcation lesions using 2-stent technique: NO DATA NOW

How to define a bifurcation lesion?

• No matter which kind of classification of bifurcation lesions, imaging characteristics is basic and important.

• But is it enough?• What’s the objective for us to treat bifurcation

using 1- or 2-stent technique? Keep two branch patency with effective anterior flow for a long time.

A bifurcation of 1-stent technique case report

• MAY, m, 70ys• Angina pectoris for over 1 mon• Risk factors: EH, EL, DM• Echo: EF 54%, LVDd 55mm

CAG result

Classification of the bifurcation

From CAG, classification of LCX-OM is 1,1,0 or 1,1,1

But how about functional result and IVUS result?

FFR of LCX-OM bif

LCX-OM

LCX-PL

Is that true of FFR for both MB and SB?

Pitfalls in FFR Measurement of Bifurcation

中心 Pd′ (SB) Pd(SB)

SB

MB

Pd(MB)

Pd′ (MB)

Pa′

Pa

Proximal MB lesion

Distal MB lesion

Distal SB lesion

FFR MB including distal MB lesion and proximal MB lesion

FFR SB including distal SB lesion and proximal MB lesion

Strategy for the bifurcation lesion only according to FFR result

1-stent strategy or 2-stent strategy?

But from FFR result, we can not define the classification 1,1,1 or 1,1,0 or 1,0,0.

Strategy for the bifurcation is 1-stent technique

Last result-after kissing

Follow-up after 10 month

FFR result at follow-up

LCX-OM

LCX-PL

Case 2 report

• Male, 63yrs, • Chest pain for 1 mon,• Risk factors: smoking, HL• DIA: UAP, EH

CAG result

After 2 stent implanted

FFR result before PCI

FFR (LAD)

FFR (D1)

From the CAG and FFR result, it’s a true bifurcation lesion of medina classification 0,1,1

FFR result after PCI

FFR (LAD) after stenting

FFR (D1) after stenting

FFR (LAD) after stenting

Follow up result after 6 mon

FFR follow-up after 6 mon

FFR (LAD)

FFR (D1)

Summary of 2 cases

• Maybe FFR is not good for classification of bifurcation lesions compared with imaging result such as angiogram or IVUS et al.

• FFR is suitable for forecasting outcome for bifurcation treatment in the future.

• We need randomized, multicenter, large sample size study for using FFR guided bifurcation PCI.

Thanks for your attention