Maybe next time anyone here has an angiogram, we should just say to the cardiologist "please make sure you use FFR please" :)
Interesting article and thanks for sharing: The reason why many hospital cardiac labs do not use the procedure may reduce their bottom line income....fewer stent implants.
For context, "an angiogram is a shadow image of the coronary artery, produced by X-rays and contrast dye to show if any blockages exist. When a cardiologist sees a blockage greater than 50%, he or she often decides to open the artery using balloon angioplasty and places a stent to hold the artery open. (I agree!)
Criticism has been leveled at this diagnostic method and has been labeled as the "oculo-stenotic reflex" -- if you see a blockage (stenosis) you automatically assume it needs to be stented. However, this is not always the case. (I agree, prior interventional cardiologist wanted to stent 72% occlusion of ICX...no symptoms).
The FAME study refuted this methodology for patients with multivessel coronary disease (narrowings in more than one artery). Using a catheter to measure the blood pressure on both sides of the blockage, called the fractional flow reserve (FFR), cardiologists were able to determine more accurately whether the plaque build-up was actually causing significant ischemia (loss of blood flow). When guided by FFR, less stents were placed and outcomes for the patients were better by 28%, when compared to stent placement guided only by the angiogram.
What the authors of this week's JACC paper have shown is that the advantage of FFR-guided stent placement exists not only in what might be called "intermediate lesions" of 50-70% (as measured by angiography) but also in more severe blockages. Two-thirds of the coronary narrowings in the 50-70% range were measured by FFR as being functionally insignificant. In other words, only one out of three blockages in this range was causing ischemia; placing a stent in two-thirds of these lesions was not only unnecessary, but could result in more adverse events. (stent recoil, stent migration, clots, etc.)
However, even in the more severe range of 71-90% blockages, one out of five stenoses were measured by FFR as being functionally insignificant -- no stent needed. It was only in the range of 91% or greater narrowing that virtually all of the lesions were significant and the patient would benefit from stenting. (that may depend whether or not there are collateral vessel development. To stent a lesion that has collaterals reduces or stops the blood flow through the collaterals).
Im referring to this device.....
http://www.ptca.org/news/2010/0623_FFR.html
I believe you are referring to an implication regarding right coronary artery dominance and/or left dominance. Consideration is the area supplied by its configuration, etc. and FFR determined the lesion's significance applicability. Lesion significance is the only redeeming asset, but effective for multi-lesion arteries.
But a competing company IVUS claims a better product and has the following that FFR doesn't and may explain why all labs may not be using FFR.
Stent Expansion X
Stent Placement X
Stent Apposition X
Stent Diameter Sizing X
Stent Length Sizing X
Plaque Burden X
Plaque Tissue Type X
% Stenosis X
Stent Placement X
Lesion Morphology
IVUS Is Clinically Relevant¹
One-year data from theWashington Hospital Center (WHC) IVUS vs. No IVUS DES Study show that patients in the IVUS group had:
65% lower stent thrombosis
29% lower TLR
The study concluded that using IVUS during DES implantation has the potential to influence treatment strategy and affect both DES thrombosis and the need for repeat procedures