Comparison FFR / IVUS for Left Main

Assoc. Prof. Jacek Legutko, MD, PhD

Jagiellonian University Medical College

University Hospital in Krakow, Poland

http://en.wikipedia.org/wiki/File:POL_Jagiellonian_University_logo.svghttp://www.su.krakow.pl/

Speaker’s name: Jacek Legutko

I have the following potential conflicts of interest to report:

Research contracts: Volcano Therapeutics

Consulting: Volcano Therapeutics

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

Potential conflicts of interest

v

v

v

Puri R, et al. J Am Coll Cardiol Intv 2012;5:697–707

Borderline Left Main Stenosis Comparison of Angio and FFR

ICUS cut-off values for FFR = 0,75:

MLD = 2,8 mm LAmin = 5,9 mm2

Jasti V, et al.. Circulation 2004;110:2831-2836

Borderline Left Main Stenosis Comparison of FFR and IVUS

Kang SJ, et al. J Am Coll Cardiol Intv 2011;4:1168–74)

Conclusions: In isolated LM disease, an IVUS-derived MLA

FFR≤0,75 –MLA≤5,9mm2

Area Under Curve = 0,81250

Sensitivity = 0,6905

Specificity = 0,8542

P

Jose M. de la Torre Hernandez, et al. J Am Coll Cardiol 2011;58:351–8

Pullback from LAD MLA = 8.26 mm² MLD = 3.14 mm

Pullback from Cx MLA = 8.71 mm² MLD = 2.79 mm

Ambiguous Left Main Disease with concomitant LAD / LCX stenosis

Limitation of IVUS assessment

Waksman R, Legutko J, et al. J Am Coll Cardiol. 2013; 61(9):917-23.

All lesions, n=367

Ref.D3,5 mm

Left Main and MVD – how to assess?

Stable angina CCS II

FFR = 0.81

FFR = 0.74

FFR = 0.76

FFR = 0.85

Adenosin – i. v. infusion 180 µg/kg/min.

LAmin = 4,2 mm2

Direct stenting

DES - 3,5 x 15 mm

16 atm Balloon postdilatation

NC - 4,0 x 8 mm

20 atm

FFR = 0.83

Ostial left main stenosis – FFR vs. IVUS

NTG i.c. bolus of 250 μg

LAmin=4,0 mm2

NTG i.c. bolus of 500 μg

LAmin=6,7 mm2

NTG i.c. bolus of 1000 μg

LAmin=9,0 mm2

Ostial left main stenosis – FFR vs. IVUS

NTG ic bolus of 250 μg Lamin=10,8 mm

2

1 year follow-up

Ostial left main stenosis – FFR vs. IVUS

Angio vs. IVUS-guided Left main PCI

All patients

Angio vs. IVUS-guided Left main PCI

Circ Cardiovasc Interv. 2011;4:562-569

Angio vs. IVUS-guided Left main PCI

Ambigous Left Main and AMI

Ambigous Left Main and AMI After 7 days of DAT

?

Ambigous Left Main and AMI

Left Main PCI with DES

Conclusions

Isolated Ambiguous Left main Stenosis:

Patient for CABG – FFR (to confirm ischemia)

Patient for PCI – IVUS (to confirm indications and guide left

main intervention)

Ostial LM stenosis – IVUS ± FFR

Culprit Lesion in AMI – IVUS

Ambiguous Left main Stenosis with concomittant LAD and

or LCX significant disease:

Use FFR to confirm ischemia

Use IVUS to assess left main disease (to choose optimal

revascularization strategy – CABG vs. PCI)