So-called ‘signicant’ atherosclerotic coronary stenosis is dened by a simple binary morphological index of tightness – percent diameter stenosis (%DS >50%). Invasive diagnosis of atherosclerotic coronary lesions classically comprises two consecutive stages, which can be fairly accurately described as angiographic visual perception and functional deduction. This anatomic–functional duality should be seen as not so much antithetic as causal and nally quite complex. The present update seeks to: dene the ambiguous relationship between functional impact and morphology in atherosclerotic coronary stenosis; to specify the means of invasive diagnosis complementing coronary angiography to compensate the anatomic and functional limitations intrinsic to the latter (cross-sectional intravascular ultrasound [IVUS] and optical coherence tomography [OCT] imaging and fractional ow reserve [FFR] determined by pressure guide); and to bring these preliminary considerations to bear on the design of algorithms to guide the use of complementary invasive diagnostic exploration and draw up a novel diagnostic strategy in interventional cardiology (rst-line coronary angiography).
Gérard Finet - Department of Coronary Artery and Valvular Diseases and Interventional Cardiology, Cardiovascular Hospital – Hospices Civils de Lyon and Claude Bernard University, INSERM U1060 (CARMEN), Lyon, France
Gilles Rioufol - Department of Coronary Artery and Valvular Diseases and Interventional Cardiology, Cardiovascular Hospital – Hospices Civils de Lyon and Claude Bernard University, INSERM U1060 (CARMEN), Lyon, France
