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Comparison FFR / IVUS for Left Main
Assoc. Prof. Jacek Legutko, MD, PhD
Jagiellonian University Medical College
University Hospital in Krakow, Poland
http://en.wikipedia.org/wiki/File:POL_Jagiellonian_University_logo.svghttp://www.su.krakow.pl/
Speaker’s name: Jacek Legutko
I have the following potential conflicts of interest to report:
Research contracts: Volcano Therapeutics
Consulting: Volcano Therapeutics
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
Potential conflicts of interest
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Puri R, et al. J Am Coll Cardiol Intv 2012;5:697–707
Borderline Left Main Stenosis Comparison of Angio and FFR
ICUS cut-off values for FFR = 0,75:
MLD = 2,8 mm LAmin = 5,9 mm2
Jasti V, et al.. Circulation 2004;110:2831-2836
Borderline Left Main Stenosis Comparison of FFR and IVUS
Kang SJ, et al. J Am Coll Cardiol Intv 2011;4:1168–74)
Conclusions: In isolated LM disease, an IVUS-derived MLA
FFR≤0,75 –MLA≤5,9mm2
Area Under Curve = 0,81250
Sensitivity = 0,6905
Specificity = 0,8542
P
Jose M. de la Torre Hernandez, et al. J Am Coll Cardiol 2011;58:351–8
Pullback from LAD MLA = 8.26 mm² MLD = 3.14 mm
Pullback from Cx MLA = 8.71 mm² MLD = 2.79 mm
Ambiguous Left Main Disease with concomitant LAD / LCX stenosis
Limitation of IVUS assessment
Waksman R, Legutko J, et al. J Am Coll Cardiol. 2013; 61(9):917-23.
All lesions, n=367
Ref.D3,5 mm
Left Main and MVD – how to assess?
Stable angina CCS II
FFR = 0.81
FFR = 0.74
FFR = 0.76
FFR = 0.85
Adenosin – i. v. infusion 180 µg/kg/min.
LAmin = 4,2 mm2
Direct stenting
DES - 3,5 x 15 mm
16 atm Balloon postdilatation
NC - 4,0 x 8 mm
20 atm
FFR = 0.83
Ostial left main stenosis – FFR vs. IVUS
NTG i.c. bolus of 250 μg
LAmin=4,0 mm2
NTG i.c. bolus of 500 μg
LAmin=6,7 mm2
NTG i.c. bolus of 1000 μg
LAmin=9,0 mm2
Ostial left main stenosis – FFR vs. IVUS
NTG ic bolus of 250 μg Lamin=10,8 mm
2
1 year follow-up
Ostial left main stenosis – FFR vs. IVUS
Angio vs. IVUS-guided Left main PCI
All patients
Angio vs. IVUS-guided Left main PCI
Circ Cardiovasc Interv. 2011;4:562-569
Angio vs. IVUS-guided Left main PCI
Ambigous Left Main and AMI
Ambigous Left Main and AMI After 7 days of DAT
?
Ambigous Left Main and AMI
Left Main PCI with DES
Conclusions
Isolated Ambiguous Left main Stenosis:
Patient for CABG – FFR (to confirm ischemia)
Patient for PCI – IVUS (to confirm indications and guide left
main intervention)
Ostial LM stenosis – IVUS ± FFR
Culprit Lesion in AMI – IVUS
Ambiguous Left main Stenosis with concomittant LAD and
or LCX significant disease:
Use FFR to confirm ischemia
Use IVUS to assess left main disease (to choose optimal
revascularization strategy – CABG vs. PCI)