Fractional Flow Reserve: A “How-To” Guide for Cardiologists

Fractional Flow Reserve wire in arteryI’ve written a lot about Fractional Flow Reserve, or FFR, in the past — and the fact that it’s a simple tool that can be used during an angiogram to assess the actual obstruction to the volume of blood flow being caused by an arterial blockage. Sure you can SEE a blockage on the fluoroscopic image, but should you stent it?

The results of the by now well-known FAME study indicate that a third of the blockages between 50% and 90% (as seen on the angiogram) actually had an FFR measurement of greater than 80% (meaning that the obstruction of flow was less than 20%, even though the blockage looked more significant on the angiogram). Most importantly, treating those blockages with angioplasty and stenting resulted in worse outcomes at one year — results which have remained constant now three years later. For more information, read our exclusive interview with Dr. Nico Pijls, co-principal investigator for FAME.

The bottom line is that fractional flow reserve guidance reduced the number of stents used by one-third while producing improved clinical outcomes by…one-third. A no-brainer: better results for patients, lower costs for the healthcare system. What’s not to like?

So in the December 1 issue of Catheterization and Cardiovascular Interventions (Volume 76, Issue 7, pages 978 –985), colleagues of Dr. Pijls, headed by Dr. Bernard De Bruyne of Belgium, published a “how-to” guide on FFR titled, “Practical tips and tricks for the measurement of fractional flow reserve“. The abstract states:

Coronary pressure measurement has emerged as one of the most promising tools to assist interventional cardiologists to make accurate clinical decisions. Fractional flow reserve (FFR) is a simple way of reliably assessing the functional consequences of coronary atherosclerosis. The training in FFR is easy, and coronary pressure measurements can be obtained swiftly in the catheterization laboratory. This review outlines the practical set up of FFR in the catheterization laboratory and also discusses the potential pitfalls in the measurement of FFR.

FFR wires are manufactured by Volcano Corporation (NASDAQ: VOLC) and St. Jude Medical (NYSE: STJ),via St. Jude’s acquisition of Radi Medical Systems of Sweden. Catheterization and Cardiovascular Interventions is the official journal of The Society for Cardiovascular Angiography and Interventions (SCAI).

The advantages of FFR in decision-making for multivessel PCI are well-documented. Learn how to do one today!

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Filed under Angiograms, FAME I / FAME II, FFR

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