FFR et bifurcation FFR et MB avant ATL

FFR et bifurcation

FFR et MB avant ATL SB MB ?

The Value of FFR in terms of Clinical Outcome Has Been Validated in patients with 1. Intermediate stenoses 2. Post-myocardial setting 3. Multivessel Disease (Pijls et al. New Engl J Med 1996) (Pijls et al. JACC 2010) (De Bruyne et al Circulation 2001) (Ntalianis et al. JACCInterv 2010) (Tonino et al. New Engl J Med 2009) 4. Left main stenosis (Hamilos, Muller et al. Circulation 2009) 5. Proximal LAD stenosis (Muller et al. JACCInterv 2011)

FFR et MB avant ATL SB MB Oui

FFR et SB avant ATL SB MB ?

Mach band in bifurcation

Lateral Inhibition (or Mach band visual effect) "Mach bands are an optical illusion consisting of an image of two wide bands, one light and one dark, separated by a narrow strip with a light-to-dark gradient. The human eye perceives two narrow bands of different brightnesses either side of the gradient that are not present in the original http: //en. wikipedia. org/wiki/Lateral_inhibition image. "

Mach band in bifurcation

Mach band in bifurcation

FFR et SB avant ATL 1. FFR overestimates the severity 2. Jailing of a pressure wire between the stent and the vessel wall is not recommended 3. Anatomical changes after MB stenting: carina shift, stent struts

FFR et SB avant ATL SB MB Peu utile

FFR et MB après ATL SB MB ?

FFR et MB après ATL t e r e t n s a P Pijls, Circulation 2002 i ’ d Samady, JACCinterv 2009

FFR et SB après ATL SB MB ?

FFR et SB après ATL 1. FFR-guided provisional SB intervention strategy is feasible and effective 2. Functional status of jailed SB lesions after DES implantation does not change significantly during follow-up Koo, European Heart Journal (2008)

FFR Basics for bifurcation Bifurcation MB FFR SB Before PCI After PCI Before PCI YES (YES) (YES and NO) After PCI YES (subset of lesions)

Anatomically significant stenosis is frequently functionally insignificant ¢ Among side branch lesions > 75% stenosis after main vessel stenting, only 27% were functionally significant. FFR = Pd Pa (Pd/Pa) Koo BK, J Am Coll Cardiol 2005

FFR can tell what you have really done…… Before PCI After MB stenting After kissing balloon

M Main prox. first A Main Accross side first D Distal first S Side branch first 1 st stent PM stenting MB stenting across SB DM Provisional stenting SKS After balloon Skirt MB stenting + SB balloon MB stenting + kissing SB ostial stenting Provisional SB Stenting is The Gold Standard ! SB SB crush minicrush 2 stents Skirt + DM Skirt + SB Elective Internal T stenting crush Culotte TAP V stenting SKS Syst. T Stenting Minicrush Crush 3 stents Extended V Trouser legs and seat Y. Louvard, CCI 2008; 71(2): 175 -8