New FFR Measuring Device to Guide Coronary Revascularization with Our Preferred Wire

Measuring fractional flow reserve (FFR) with a 0.014 pressure wire is the standard to assess the functional significance of epicardial coronary artery stenosis. The use of FFR in the clinical practice lags despite strong supporting evidence. Some of the reasons behind this are technical aspects, like pressure wire handling limitations when assessing certain lesions, or how frustrating it can be to lose position and to have to recalibrate pressures when there is too much drift and we are no longer sure the value we have obtained is the real one.

Nuevo dispositivo para medición del FFR permite cruzar la lesión con nuestra guía preferida

An optical pressure monitoring microcatheter has recently been developed, which can be advanced over a traditional 0.014 guidewire (the one we prefer, the one we use in most cases) and allows us to pull back without losing lesion position. The potential disadvantage of this system might be that it has a higher profile than the pressure wire alone, and this might exaggerate stenosis values, overestimating FFR measurement.


Read also: What Is the Long-Term Outcome of Lesions Deferred Using FFR/iFR?”


 

Primary end point was the difference between both measurements, assuming as gold standard the pressure wire value.

 

The mean difference between the microcatheter and the pressure wire measurements was 0.022 (CI 95%, −0.029 to −0.015). On multivariable analyzis, reference vessel diameter (p=0.027) and lesion length (p=0.044) were independent predictors of bias between the 2 measurements.


Read also: Physiologically Assessing Intermediate Stenosis: Could FFR Be Replaced?”


 

Conclusion

 

FFR measurement with Navvus microcatheter, especially designed to this end, tends to render lower values than pressure wire derived FFR, but the diagnostic and therapeutic impact of this difference seems minimal in most cases.  

 

Editorial Comment

From the physiological point of view, adding a microcatheter will most likely have a higher impact in lesion flow than pressure wire alone, leading to a higher gradient and, ultimately, a lower FFR, especially in longer lesions and thinner vessels.

 

The more severe the measurement, the bigger the difference observed vs. the pressure wire, though in most cases, both values resulted functionally significant, so the clinical impact that could change diagnosis and therapy was not modified.

 

A second generation of microcatheters with a much lower profile is already available, though it has not been tested in this study. On the other hand, FFR guidewires have also evolved, with better torque and handling. At some point, one of these wires will cross the finish line and, most likely, it will be the easiest to handle.

 

Original title: ACIST-FFR Study (Assessment of Catheter-Based Interrogation and Standard Techniques for Fractional Flow Reserve Measurement).

Reference: William F. Fearon et al. Circ Cardiovasc Interv. 2017 Dec;10 (12).


Suscríbase a nuestro newsletter semanal

Reciba resúmenes con los últimos artículos científicos

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....