1 / 29

TAVOLA ROTONDA Quale Ruolo Clinico e Quale Rimborso per la Franctional Flow Reserve?

Bologna 21 Aprile 2011. TAVOLA ROTONDA Quale Ruolo Clinico e Quale Rimborso per la Franctional Flow Reserve?. Correlazioni a natomo-funzionali FFR vs IVUS. Luigi Vignali , Parma. IVUS guidance in PCI Indications. Stent Mal apposition. IVUS in evaluation for Post dilatation needs.

colman
Download Presentation

TAVOLA ROTONDA Quale Ruolo Clinico e Quale Rimborso per la Franctional Flow Reserve?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bologna 21 Aprile 2011 TAVOLA ROTONDAQuale Ruolo Clinico e Quale Rimborso per la Franctional Flow Reserve? Correlazioni anatomo-funzionali FFR vs IVUS Luigi Vignali, Parma

  2. IVUS guidance in PCIIndications

  3. Stent Mal apposition IVUS in evaluation forPost dilatation needs Posdil Pre Stent • Post-dilatation strategy: • With non-compliant balloon shorter than stent in presence of vessel remodelling or uncompleted-apposition Under expansion IVUS reveals need of postdilatation

  4. Recommendations for specific percutaneous coronary intervention devices IVUS-guided stent implantation may be considered for unprotected left main PCI EVIDENCE C CLASS IIb

  5. IVUS in ISRBeware that expected ISR might reveal under expanded stent during previous intervention. Because the vessel and plaque and stents became visible, IVUS guidance clarify substrate in failure or previous PCI, and frequently discover under expanded stents IVUS reveals stent underexpansion in ISR

  6. Performance Comparison, OCT vs IVUS C7XR IVUS

  7. Image Comparison Edge dissection during stent implantation ??? • Neointimal growth on previously implanted stent at follow-up ??? 10

  8. Validation of IVUS Assessment of Ischemia-producing Stenoses (Doppler FloWire, SPECT, and Pressure Wire) IVUS MLA 4.0mm2 IVUS MLA <4.0mm2 CFR < 2.0 2 27 CFR  2.0 39 4 Diagnostic accuracy = 92%. Abizaid et al. Am J Cardiol 1998;82:42-8 IVUS MLA 4.0mm2 IVUS MLA <4.0mm2 + Spect 4 42 Takagi, et al. Circulation 1999;100:250-5 - Spect 20 1 Diagnostic accuracy = 93%. Nishioka et al. J Am Coll Cardiol 1999;33:1870-8

  9. IVUS in intermediate assessmentProximal LAD, CX, RCA Intermediate stenosis assessment: If in Proximal LAD, CC or RCA, the stenosis MLA ≤ 4 mm2 then is cause isquemia; and must be treated Takagi, et al. Circulation 1999;100:250-5 IVUS reveals significance of intermediate lesions, with morphological assessment

  10. Clinical follow-up in 357 Intermediate Lesions in 300 Pts with Deferred Intervention after IVUS Imaging DM no-DM IVUS MLD (mm) Death/MI/TLR TLR 4 3 2 1 r=0.339 0 0 1 2 3 4 2-3 3-4 4-5 5 2-3 3-4 4-5 5 QCA MLD (mm) IVUS MLA (mm2) IVUS MLA (mm2) • Death/MI/TLR @ (mean) 13 mos = 8% overall (2% death/MI and 6% TLR) • Death/MI/TLR @ (mean) 13 mos = 4.4% in lesions with MLA >4.0mm2 • Only independent predictor of death/MI/TLR was IVUS MLA (p=0.0041) • Independent predictors of TLR were DM (p=0.0493) and IVUS MLA (p=0.0042) Abizaid et al. Circulation 1999;100:256-61

  11. In Intermediate stenosis assessment: Event Free Survival is better for the IVUS Criteria vs. the FFR >0.75 Criteria.

  12. Follow-up of 122 patients with moderate LEFT MAIN disease Indipendent predictors of MACE @11.7 Months:DM (p=0.004) and IVUS MLD (p=0.005)- but NOT the palque burden Abizaid, et al. J Am Coll Cardiol 1999;34:707-715

  13. IVUS in intermediate assessment in Left Main Intermediate Main Left stenosis assessment: If Main Left MLA ≤ 6 mm2 cause isquemia and must be treated Abizaid, et al. J Am Coll Cardiol 1999;34:707-715 IVUS assess significance of Main Left lesions, where angio fails

  14. IVUS determinants of LMCA FFR<0.75 Jasti et al Circulation 2004; 110;2831-6

  15. MULTICENTERDED LITRO STUDY INTERMEDIATE LEFT MAIN CORONARY ARTERY LESION Kaplan-Meier survival free from mortality and infarction DEF 98.1% REV 93.4% Logrank test: p = 0.04 Cumulative proportion surviving 179 pt MLA>6 mm2 (DEF group) 331 Patients 152 pt MLA<6 mm2 (REV group) PCI 44% CABG 55% 0 12 24 Months Jose’ M de la torre Hernandez et al.JACC 2010;vol55

  16. IVUS Criteria for a “significant” LMCA stenosis Absolute lumen CSA <5.9 mm2 (or MLD < 2.8 mm) is the suggested criterion for significant LMCA stenosis

  17. LA= 5,5 LA= 4,5 LA= 8,0 FFR= 0,70

  18. FFR vs IVUS in Intermediate Coronary Lesions 167 consecutive patients (FFR-guided,83 lesion vs IVUS-guided,94 lesion) 100 100 90 75 91.5% Event Free Survaival (%) 80 50 P>0.05 70 33,7% 25 60 0 FFR guided IVUS guided 400 100 200 300 The rate of performing PCI according to guiding device Time to event (days) Cutoff value FFR 0.80 Cutoff value IVUS MLA >4mm2 Chang-Wook Nam et al 2010;JACC interventions vol 3 :812-7

  19. CORRELATION BETWEEN FFR AND IVUS LUMEN AREA IN 150 INTERMEDIATE CORONARY STENOSIS For lesion with vessel reference diameters of 2.5-3 mm, 3-3.5 mm and >3.5 mm, the MLA threshold for FFR <0.8 were 2.5,2.8 and 3.7 mm2 respectively Itsik Ben-Dior, Ron Waksman et al 2011.JACC

  20. FFR= 0,74

  21. COMPLEMENTARY ROLE IVUS FFR OCT PRE INTERVENTION IVUS vessel size lesion lenght FFR Severity lesion POST INTERVENTION Expansion Apposition Coverage Complication IVUS Underexpansion Edge problems OCT INDICATION 1 Year after DES Implantation 1 Year after BMS Implantation Immediatelly after stent implantation Delayed healing; new intimal growth

  22. Thank you for your attentionFor any correspondence: gbiondizoccai@gmail.comFor these and further slides on these topics feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

More Related