| Sıra | DOSYA ADI | Format | Bağlantı |
|---|---|---|---|
| 01. | Donor Vessels Donor Collateral | pptx | Sunumu İndir |
Transkript
The impact of CTO PCI upon FFR and iFR of the collateral donor vesselsGrigoris Karamasis et al. Consultant Interventional Cardiologist Essex Cardiothoracic CentreUK
Coronary Chronic Total Occlusion (CTO)• A common finding in patients with CAD• Contemporary CTO PCI has excellent success rate and low complications• Usually in the context of multi-vessel diseaseTsai et al. JACC Cardiovasc Interv. 2017Sapontis et al. JACC Cardiovasc Interv. 2017Maeremans et al. JACC 2016
FFR superior to angiography in guiding stable CAD PCITonino et al. NEJM 2009FAME study
iFR not inferior to FFRDEFINE-FLAIR iFR-SWEDEHEARTDavies et al. NEJM 2017 Gotberg et al. NEJM 2017
Are FFR & iFR accurate in vessels providing collaterals to CTOs ?
IMPACT-CTO study• Single centre prospective observational study• 40 consecutive patients with RCA CTO and stable angina were recruited• 32 patients had successful PCI• FFR, iFR and FFRcoll were measured pre, immediately post and at 4 months follow up• Donor vessels were discriminated to major and minor according to collateral contribution• Clinical Trials.gov NCT 02643940
Physiological indices• FFR = Pd/Pa during maximum hypereamia• iFR = Pd/Pa during “wave free period” in diastole • FFRcoll = (Pw-Pra)/(Pa-Pra) Pd = distal coronary pressure Pa = aortic pressurePw = wedge pressure Pra = right atrial pressurePiljs et al. Circulation 1995Sen et al. JACC 2012
IMPACT-CTO procedure protocolFFR& iFR
Demographic characteristicsn (%) or mean ± SD Male 30 (88.2)Age (years) 61.76 ± 10.53Previous MI 21 (61.8)Previous PCI 14 (41.2)Hypertension 22 (64.7)Hypercholesterolaemia 24 (70.6)Diabetes mellitus 9 (26.5)Current smoker 7 (20.6)Angina Duration (months) 39.88 ± 65.58Angina CCS Class (1/2/3/4) 4(11.8) / 12(35.3) / 17(50.0) / 1(2.9)Estimated duration of CTO (weeks) 221.38 ± 397.30LVEF on CMR (%) 51.26 ± 19.61Ischaemia in RCA territory on CMR (%) 13.65 ± 5.00
Angiographic Characteristics n (%) or mean ± SD CTO length (mm) 34.59 ± 25.70J-CTO Score (0/1/2/3/4) 7(20.6) / 5(14.7) / 8(23.5) / 10(29.4) / 4(11.8)LAD Predominant donor vessel 30 (88) Predominant donor vessel stenosis on QCA (%)41.43 ± 12.59Minor donor vessel stenosis on QCA (%)35.06 ± 13.72Diffuse disease (PDV / MDV) 19 (55.9) / 5 (14.7)
FFR & iFR changes in minor donor vessel
FFR & iFR pre vs. immediately post in major donor vesselmean dFFR -0.01, p = 0.267 mean diFR + 0.02, p = 0.012 0.76 0.75 0.86 0.88
FFR & iFR pre vs. follow up in major donor vesselmean diFR +0.04, p = 0.003 mean dFFR +0.03, p = 0.047 0.760.79 0.86 0.90
Functional assessment of collaterals pre, post and at follow up 0.31± 01 0.34±0.1 0.19±0.1
% of lesions changed from ischaemic to non-ischaemic at follow up% lesions 18%25%FFR iFR
Conclusions• FFR and iFR in predominant donor vessel increased post CTO PCI.• FFR changed only at f/up. iFR increased immediately post PCI with a further increase at f/up.• Collateral function remained unchanged immediately post-PCI, but decreased significantly at follow-up.• These changes led to functional severity reclassification of an important number of lesions at f/up.
Questions ? grigoris.karamasis@btuh.nhs.uk
Procedural details n (%) or mean ± SD No of stents in RCA CTO (1/2/3/4/5) 8/7/9/8/2Length of stented segment (mm) 71.41 ± 30.17Technique of recanalisationAntegrade Lumen-Lumen 19 (0.56)Antegrade Dissection Re-entry 4 (0.12)Retrograde Lumen-Lumen 2 (0.06)Retrograde Dissection Re-entry 9 (0.26)Procedural time (mins) 197.29 ± 52.53Radiation (cGycm/2) 29132.65 ± 34974.37
Angiographic grading of CollateralsRentrop Classification gradingPre-CTO PCI (0/1/2/3) 0(0.0) / 0(0.0) / 2(5.9) / 32(94.1)Post-CTO PCI (0/1/2/3) 3(8.8) / 25(73.5) / 6(17.6) / 0(0.0)Collateral Connection Classification grading Pre-CTO PCI (0/1/2/3) 0 (0.0) / 3(8.8) / 22(64.7) / 9(26.5)Post-CTO PCI (0/1/2/3) 23(67.6) / 10(29.4) / 0(0) / 1(2.9)
Donor Vessels Donor Collateral
Yıl : 2020
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