TY - JOUR
T1 - Optimizing Coronary Angioplasty with FFR and Intravascular Imaging
AU - Abudayyeh, Islam
AU - Tran, Bao G.
AU - Tobis, Jonathan Marvin
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Purpose of Review: Percutaneous coronary intervention has changed the approach to coronary artery disease management, but angiography remains the principal method for determining the severity of disease. Because an angiogram only identifies the outline of the lumen, angiography is not the most sensitive or accurate instrument. This leads to significant inter-observer variation in interpretation of intermediate lesions. Additional technologies have been developed to better evaluate the extent of disease and identify potential high risk lesions. This paper reviews the strengths and deficits of these techniques. Recent Findings: Clinical outcomes data validate the use of fractional flow reserve (FFR) for physiologic assessment of coronary artery stenosis. Intravascular imaging technology provides unique anatomic information about atherosclerotic plaque. Optical coherence tomography (OCT) has high resolution for visualizing stents and inner-lumen anatomy such as dissections. Intravascular ultrasound (IVUS) has less spatial resolution but has greater penetrating power and therefore provides a more complete picture of atherosclerotic plaque. VH has not been adequately validated and can be misleading compared with tissue histology. NIRS is an emerging technology and, while promising, has not yet achieved widespread application. Summary: Invasive evaluation is an essential part of coronary artery disease assessment. Some of the techniques in use such as FFR have shown correlation with outcomes and clinical endpoints. Other technologies such as IVUS or OCT provide an anatomic description of the vessel. The use of these imaging tools to describe lesion composition and predict vulnerable plaque has not been as successful or clinically robust.
AB - Purpose of Review: Percutaneous coronary intervention has changed the approach to coronary artery disease management, but angiography remains the principal method for determining the severity of disease. Because an angiogram only identifies the outline of the lumen, angiography is not the most sensitive or accurate instrument. This leads to significant inter-observer variation in interpretation of intermediate lesions. Additional technologies have been developed to better evaluate the extent of disease and identify potential high risk lesions. This paper reviews the strengths and deficits of these techniques. Recent Findings: Clinical outcomes data validate the use of fractional flow reserve (FFR) for physiologic assessment of coronary artery stenosis. Intravascular imaging technology provides unique anatomic information about atherosclerotic plaque. Optical coherence tomography (OCT) has high resolution for visualizing stents and inner-lumen anatomy such as dissections. Intravascular ultrasound (IVUS) has less spatial resolution but has greater penetrating power and therefore provides a more complete picture of atherosclerotic plaque. VH has not been adequately validated and can be misleading compared with tissue histology. NIRS is an emerging technology and, while promising, has not yet achieved widespread application. Summary: Invasive evaluation is an essential part of coronary artery disease assessment. Some of the techniques in use such as FFR have shown correlation with outcomes and clinical endpoints. Other technologies such as IVUS or OCT provide an anatomic description of the vessel. The use of these imaging tools to describe lesion composition and predict vulnerable plaque has not been as successful or clinically robust.
KW - Fractional flow reserve
KW - Interventional cardiology
KW - Intravascular imaging
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U2 - 10.1007/s12170-017-0534-9
DO - 10.1007/s12170-017-0534-9
M3 - Review article
SN - 1932-9520
VL - 11
JO - Current Cardiovascular Risk Reports
JF - Current Cardiovascular Risk Reports
IS - 2
M1 - 7
ER -