Medication Summary

The goal of pharmacotherapy is to measure the fractional flow reserve (FFR) to decide whether a coronary intervention would be beneficial.

Class Summary

A hyperemic agent such as adenosine may be used to evaluate FFR.

Adenosine (Adenocard, Adenoscan)

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Adenosine slows conduction time through the AV node. It can interrupt atrioventricular reentrant tachycardia (AVRT) by blocking conduction in the AV node to restore normal sinus rhythm in paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with Wolff-Parkinson-White (WPW) syndrome. It should not be given to patients with preexcitation unless by a cardiac electrophysiologist.

Locate the pressure sensor adjacent to the tip of the guide catheter, and perform a normalization procedure with the instrument. Advance the sensor to the desired measurement location, and perform measurements with the instrument. If the FFR is greater than 0.75 at baseline, proceed with administering a hyperemic stimulus (eg, intracoronary adenosine in a dose of 15-40 µg or IV adenosine at 140 µg/kg/min), and monitor measurements.

Finally, withdraw the pressure sensor and verify that pressures are equal.

Questions

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Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005 Apr. 26(8):804-47. [QxMD MEDLINE Link].
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Fischer JJ, Samady H, McPherson JA, et al. Comparison between visual assessment and quantitative angiography versus fractional flow reserve for native coronary narrowings of moderate severity. Am J Cardiol. 2002 Aug 1. 90(3):210-5. [QxMD MEDLINE Link].
Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007 May 29. 49(21):2105-11. [QxMD MEDLINE Link].
Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009 Jan 15. 360(3):213-24. [QxMD MEDLINE Link].
Stundl A, Shamekhi J, Bernhardt S, et al. Fractional flow reserve in patients with coronary artery disease undergoing TAVI: a prospective analysis. Clin Res Cardiol. 2019 Nov 2. [QxMD MEDLINE Link].
Coronary physiology: overview. Volcano Corporation. Available at http://www.volcanocorp.com/products/functional-measurement.asp. Accessed: 5/28/2010.
St Jude Medical. Available at http://www.radi.se/kc_home.aspx?n=start&r=1. Accessed: 5/28/2010.
Diletti R, Van Mieghem NM, Valgimigli M, et al. Rapid exchange ultra-thin microcatheter using fibre-optic sensing technology for measurement of intracoronary fractional flow reserve. EuroIntervention. 2015 Aug. 11(4):428-32. [QxMD MEDLINE Link].
Verdier-Watts F, Rioufol G, Mewton N, et al. Influence of arterial hypotension on fractional flow reserve measurements. EuroIntervention. 2015 Aug. 11(4):416-20. [QxMD MEDLINE Link].

Media Gallery

Fractional flow reserve measurement (FFR). Angiography of the right coronary artery demonstrates an intermediate-grade lesion in the mid vessel. Intermediate-grade lesions such as this should be further evaluated with fractional flow reserve measurement.
Fractional flow reserve measurement (FFR). RadiAnalyzer Xpress when initially powered on.
Fractional flow reserve measurement (FFR). PressureWire is placed outside of the guide catheter but proximal to the lesion to equalize pressure wire and aortic pressures.
Fractional flow reserve measurement (FFR). RadiAnalyzer Xpress demonstrating aortic and PressureWire pressures prior to crossing the lesion. Notice that the ratio is not equal to 1, indicating that further adjustments to the instruments are needed. Red line = aortic pressure. Green line = pressure at the wire tip.
Fractional flow reserve measurement (FFR). PressureWire is placed distal to the lesion in the right coronary artery.
Fractional flow reserve measurement (FFR). With the administration of intravenous adenosine, the fractional flow ratio decreases to 0.67, indicating that the lesion is hemodynamically significant and will benefit from revascularization. Red line = aortic pressure. Green line = pressure at the wire tip.
Fractional flow reserve measurement (FFR). Angiography of the right coronary artery after percutaneous coronary intervention.
Fractional flow reserve measurement (FFR). Demonstration of calibration and use of a RadiAnalyzer Xpress.