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February
8,
2011 -- 8:15pm EST
Fractional Flow Reserve: A "How-To" Guide for
Cardiologists
I'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.
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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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