Why Fractional flow reserve (FFR) measurement NOT intended to be done in case of CTO?

  • Fractional flow reserve (FFR) measurement NOT intended to be done in case of CTO because of False positive result because of recruitment of collaterals.
  • FFR is influenced by the amount of myocardium subtended by a stenosis
  • Presence of a CTO could thus lead to a “false positive” FFR in the donor vessel.
  • After CTO-PCI, recruitment of collaterals rapidly diminished, with the donor vessel going back to supply a smaller volume of myocardium with a consequent trend towards normalization of FFR values

Fractional flow reserve (FFR) measurement NOT intended to be done in case of

[A] Identify the precise location of a coronary lesion
[B] Identify appropriate culprit lesion in multivessel coronary artery disease
[C] Angiographically intermediate LCX lesion
[D] Chronic total occlusion

  • Fractional flow reserve (FFR) measurement involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery.
  • An FFR of 1.0 is widely accepted as normal.
  • An FFR lower than 0.75-0.80 is generally considered to be associated with myocardial ischemia (MI)
  • It provides a quantitative assessment of the functional severity of a coronary artery stenosis identified during coronary angiography and cardiac catheterization.

Indications

Indications for FFR measurement are as follows:

  1. To determine the physiologic and hemodynamic significance of an angiographically intermediate coronary stenosis
  2. To identify appropriate culprit lesion(s) in multivessel coronary artery disease (CAD)
  3. To measure the functional importance of stenosis in the presence of distal collateral flow
  4. To identify the precise location of a coronary lesion when the angiographic image is unclear

Note that this procedure is not intended for use in the setting of a total vessel occlusion.

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