Fractional Flow Guided Coronary Artery Bypass Grafting: A Word of Caution
The traditional basis for all forms of coronary artery revascularization has been the percent stenosis due to an atherosclerotic plaque or thrombotic occlusion based on coronary angiography. With the introduction of Fractional Flow Reserve (FFR) technology, a new gold standard has been developed to assess the severity of a coronary artery stenosis which takes into account the physiology of that stenosis.
FFR is defined as the ratio of maximal blood flow across a stenotic lesion compared to normal maximal flow. It is measured using a coronary pressure guidewire and is compared to the aortic pressure measured simultaneously with the guide catheter during maximum hyperemia. An FFR value of < 0.80 is predictive of a coronary stenosis responsible for ischemia with an accuracy > 90%1. The FFR technique requires some extra manipulation during the cath and a central line may be necessary if IV adenosine is used to elicit the maximal hyperemic response. Although there is potential for trauma to the coronary vessel, this complication is rarely reported.
- Received August 21, 2013.
- Accepted August 22, 2013.