Fractional Flow Reserve - The Left Main and Coronary Artery Bifurcation Lesion Summit (CBS)

Abstract

New Volumetric Analysis Method for Stent Expansion and its Correlation With Final Fractional Flow Reserve and Clinical Outcome An ILUMIEN I Substudy
Fractional flow reserve-guided PCI for stable coronary artery disease
Physiological Stratification of Patients With Angina Due to Coronary Microvascular Dysfunction
Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity
Coronary fractional flow reserve in bifurcation stenoses: what have we learned?
The impact of downstream coronary stenoses on fractional flow reserve assessment of intermediate left main disease
The Natural History of Nonculprit Lesions in STEMI: An FFR Substudy of the Compare-Acute Trial
Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve - COMFORTABLE Retrospective Study
Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial
Individual Lesion-Level Meta-Analysis Comparing Various Doses of Intracoronary Bolus Injection of Adenosine With Intravenous Administration of Adenosine for Fractional Flow Reserve Assessment

Original Research

Volume 11, Issue 15, August 2018

JOURNAL：JACC Cardiovasc Interv.

New Volumetric Analysis Method for Stent Expansion and its Correlation With Final Fractional Flow Reserve and Clinical Outcome An ILUMIEN I Substudy

D Nakamura, W Wijns, MJ Price et al.

3231

Keywords: fractional flow reserve; optical coherence tomography; restenosis; stent expansion

ABSTRACT

OBJECTIVES - This study sought to compare conventional methodology (CM) with a newly described optical coherence tomography (OCT)-derived volumetric stent expansion analysis in terms of fractional flow reserve (FFR)-derived physiology and device-oriented composite endpoints (DoCE).

BACKGROUND - The analysis of coronary stent expansion with intracoronary imaging has used CM that relies on the analysis of selected single cross-sections for several decades. The introduction of OCT with its ability to perform semiautomated volumetric analysis opens opportunities to redefine optimal stent expansion.

METHODS - A total of 291 lesions treated with post-stent OCT and FFR were enrolled. The expansion index was calculated by using a novel volumetric algorithm and was defined as: ([actual lumen area / ideal lumen area] × 100) for each frame of the stented segment. The minimum expansion index (MEI) was defined as the minimum value of expansion index along the entire stented segment. MEI and conventional lumen expansion metrics were compared for the ability to predict post-stent low FFR (<0.90) and DoCE at 1 year.

RESULTS - There was a stronger correlation between MEI and final FFR, compared with CM and final FFR (r = 0.690; p < 0.001) versus (r = 0.165; p = 0.044). MEI was significantly lower in patients with DoCE than those without DoCE (72.18 ± 8.23% vs. 81.48 ± 11.03%; p < 0.001), although stent expansion by CM was similar between patients with and without DoCE (85.05 ± 22.19% and 83.73 ± 17.52%; p = 0.858), respectively.

CONCLUSIONS - OCT analysis of stent expansion with a newly described volumetric method, but not with CM, yielded data that were predictive of both an acute improvement in FFR-derived physiology and DoCE.