Author + information
- Received May 21, 2018
- Accepted May 29, 2018
- Published online July 18, 2018.
- Takayuki Yabe, MD∗ (, )
- Toshiya Muramatsu, MD,
- Reiko Tsukahara, MD,
- Masatsugu Nakano, MD,
- Satoru Nishio, MD,
- Yukako Takimura, MD,
- Hideyuki Takimura, MD,
- Mami Kawano, MD and
- Tasuku Hada, MD
- ↵∗Address for correspondence:
Dr. Takayuki Yabe, Cardiology, Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo 165-0022, Japan.
A 54-year-old male patient presented with a symptomatic bifurcation lesion of 75% stenosis in LAD (Figure 1A). Physiological evaluation was performed using instantaneous wave-free ratio (iFR) roadmap (Philips Healthcare, Best, the Netherlands) functionality (1). First, we ran a fluoroscopy-activated Dynamic Coronary Roadmap (DCR) (Philips Healthcare) in Azurion 7C20 (Philips Healthcare) by using an automatically created mask of the coronary tree of every frame in that run and placed those in an image library. In fluoroscopy, a roadmap is retrieved from the image library matching the same C-arm angulation and cardiac phase by comparing the shape of the guiding catheter in the mask with the shape in the live image (Figure 1B). Subsequently, the pressure guidewire (Verrata, Philips Healthcare) was advanced distally in the left anterior descending artery while using the DCR for guidance (Figure 2A). No additional contrast puffs were mandatory. The distal iFR value was 0.86. During the iFR pullback the software matched the iFR scout values to the location of the wire on the DCR, which are displayed right beside of image with coregistration. The iFR Roadmap showed a jump of 0.87 (Figure 2B) to 0.91 (Figure 2C) from the distal to the proximal part of the lesion. As there were no other jumps it was clear to treat only this lesion. Each wire was advanced to the main and side branch using the DCR system (Figure 1C). Subsequently, a 3.0 × 23 mm stent (XIENCE Alpine, Abbott Vascular, Santa Clara, California) was placed (Figures 1D and 1E) and the procedure was terminated (Figure 1F).
Both physiological assessment of lesion severity and optimizing vessel revascularization strategy for keeping minimum contrast volume are becoming important in coronary interventions. This is the first report of the tool such as the iFR roadmap shows the potential to aid in providing the best care to the patient.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 21, 2018.
- Accepted May 29, 2018.
- 2018 American College of Cardiology Foundation