Post POT-KISS-POT FFR Measurements For A Multi-vessels Disease Patient

Today, interventional cardiologists are increasingly treating patients with complex diseases. To achieve physiologically successful revascularizaiton, physicians have gradually adopted post-PCI assessement. The TruePhysio® pressure microcatheter is excellent in maintaining the wire position while being pulled back, either pre- or post-PCI. Below case operated by Prof. Barbato highlights how the TruePhysio® pressure microatheter facilitates physiological assessment for a patient with multi-vessel and bifurcation disease pre- and post-PCI.

Patient history

• 72-year-old female

• Multi-vessel disease

• Risk factors: Type II Diabetes Mellitus, Dyslipidemia and Obesity (BMI 35.2)

• Due to inferior STEMI, the primary PCI to RCA (DES 3mm x 23mm) was performed in Dec. 2012

Case challenges

• Bifurcation (LAD-D1),

• Multi-vessel disease (LAD, LCX)

• Side branch physiological assessment by crossing the stent struts

Coronary angiography

Coronary angiography

This case highlights:

• The necessity to have microcatheter-based physiology techniques in the Cath Lab which allows physicians to measure FFR values after stent placement

• The TruePhysio® pressure microcatheter facilitated the operator to evaluate the function of the side branch after the POT-Kiss-POT technique

• The ease of use of the TruePhysio® pressure microcatheter in physiology assessments

LCX and OM1 Lesion

• TruePhysio® pressure microcatheter was delivered in the LCX distal to the lesion. After papaverine injection, FFR = 0.90 (Fig. 1)

• The same workhorse wire was pulled back from the LCX, then navigated to distal OM1, without much effort

• TruePhysio® pressure microcatheter followed the above workhorse wire and measured OM1 FFR as 0.91 (Fig. 2)

LAD and D1 Bifurcation Lesion

• After delivering to the distal LAD and acquiring an FFR value of 0.76 (Fig. 3), TruePhysio® pressure microcatheter was pulled back for discerning the most severe lesion. Intervention to this lesion was decided

• Predilating the lesion using a 2.5 x 15mm semi-compliant balloon then an everolimus-eluting stent was placed

• Using a 3.0 x 12mm non-compliant balloon for proximal optimization technique (POT)

• After wire exchange, kissing was performed with 2 semi-compliant balloons (3.0 × 15 mm placed in LAD and 2.0 × 15 mm placed in D1)

• Final POT was performed with a 3.0 × 12 mm NC balloon

• Post-PCI FFR for distal LAD was 0.93 (Fig. 4), indicating the ischemia was relived

• Pullback assessment showed the residual disease in LAD were diffuse, which would be benefited more by medical treatment.

• TruePhysio® pressure microcatheter was advanced to the distal D1 without any effort and given an FFR value of 0.90 (Fig. 5), with satisfactory angiographic results (Fig. 6)

Summary

• The TruePhysio® pressure microcatheter could be conveniently delivered to the desired position.

• Microcatheter-based FFR measurement takes <1 minute.

• No need to rewire for post-PCI measurements.

• The TruePhysio® pressure microcatheter can advance directly to the landing zone and the physician only need to administer contrast media while positioning the guidewire.

PHYSICIAN COMMENTS

• This microcatheter based FFR measurement system introduces a significant degree of simplification in our invasive functional assessment which is a major step forward in our daily practice.

• With a traditional pressure wire I would never performed a FFR measurement of the diagonal branch after a POT-Kiss-POT procedure.

• It is astonishing to perform a satisfactory functional physiology evaluation in such a short time frame.