Introduction of Fractional Flow Reserve And Optical Coherence Tomography

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Angiography has long been considered the gold standard in guiding coronary interventional therapies. However, well-documented limitations of angiography necessitate the use of more advanced imaging and functional hemodynamic evaluation to arrive at optimal decisions regarding revascularization.1 Contemporary guideline-driven practice dictates revascularization only for ischemia-causing lesions and medical therapy for other lesions.2,3 For this reason, accurate assessment of the functional significance of a lesion (ischemic vs. nonischemic) using noninvasive or invasive techniques is very important.

Inherent and logistical limitations of noninvasive stress testing decrease the applicability of this diagnostic technique both in- and outside the catheterization laboratory in regard to making decisions on revascularization (e.g., multivessel disease and balanced ischemia, artifact, tolerance to test). Angiographic evaluation of intermediate lesions for ischemic significance is also challenging and often requires a noninvasive functional evaluation or lab assessments. Fractional flow reserve (FFR), in contrast, enables functional evaluation in the cath lab and delivers gold standard ischemia detection.

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