Workhorse-like FFR wire assesses complex case with 90° angle

As interventional cardiologists are being presented with more complex patients, FFR is an increasingly important tool to guide PCI. This case highlights the need for an FFR wire that can be used in highly tortuous anatomy.

CASE STUDY


Case Study Prof. Gianluca Campo and Dr. Matteo Tebaldi from the Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Italy Case Study Prof. Gianluca Campo and Dr. Matteo Tebaldi from the Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Italy


Prof. Gianluca Campo and Dr. Matteo Tebaldi from the Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Italy

 

Patient History

  • Female 76 years old with hypertension & diabetes mellitus
  • Renal dysfunction (serum creatinine 2 mg/dl)
  • Previous coronary angiography (5 years ago) for stable angina: not significant stenosis with indication to optimal medical therapy (not pictured)
  • Recent admission to surgical department for liver resection (high risk surgery > 5%)
  • Cardiovascular assessment pre surgery resulted in: functional capacity < 4 mets and chest pain during intense effort
  • Indication to perform coronary angiography

Case Challenges

  • Significant angulation and tortuosity: may be difficult to deliver FFR wire
  • “Oculo-stenotic” assessment may determine PCI on both obtuse marginal (OM) and left anterior descending and therefore DAPT are needed

Coronary Angiography Performed

  • Note: Access to first OM was difficult at a 90º angle. This was complicated by an additional stenosis immediately after the ostium
  • Second obtuse marginal: no change from the previous examination
  • LAD showed a 65% stenosis in the distal segment

COMETTM FFR Pressure Guidewire Characteristics

  • Asahi co-developed for true workhorse capabilities
  • Free rotation while steering and reliable re-connection 
  • Optical pressure sensor

FFR of LAD

  • The COMETTM FFR wire was delivered down the LAD and gives an FFR value of 0.83
  • No stents placed

FFR COMET fig 2 FFR COMET fig 2

FFR value of 0.83

FFR of Second Obtuse Marginal

  • COMETTM FFR wire delivers down a highly tortuous vessel with 90º angle

 

FFR COMET fig 1 FFR COMET fig 1

FFR of 0.95

 

Key learnings

This case highlights:

  • The need to have available new, modern FFR guide wires that allow the operator to analyse complex, tortuous vessels with angulation. 

  • In this case FFR helped the operator avoid unnecessary PCI and DAPT treatment thereby keeping the surgical option open if deemed necessary in the future.

 

 

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