Intravascular imaging and physiologic lesion assessment to define critical coronary stenoses Luis Gruberg, MD, Gary S Mintz, MD, Lowell F Satler, MD,

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Intravascular imaging and physiologic lesion assessment to define critical coronary stenoses Luis Gruberg, MD, Gary S Mintz, MD, Lowell F Satler, MD, Kenneth M Kent, MD, Augusto D Pichard, MD, Martin B Leon, MD The Annals of Thoracic Surgery Volume 68, Issue 4, Pages 1547-1551 (October 1999) DOI: 10.1016/S0003-4975(99)00960-1

Fig 1 An asymptomatic 56-year-old female patient with normal left anterior descending and left circumflex arteries had in intermediate lesion in the “mid portion” of the right coronary artery. Quantitative coronary angiography of the lesion revealed a reference vessel diameter of 2.44 mm and a percent diameter stenosis of 52% (Panel A). Intravascular ultrasound imaging showed four “stenoses.” All four are shown relative to the coronary angiogram. The worst stenosis (A) has a minimum lumen area of 1.6 mm2 and a minimum lumen diameter of 1.1 mm. However, at least two others fit the IVUS criterion of significance (minimum lumen area less than 4.0 mm2): they are labeled (B) and (D). There is significant ostial disease (A) as well. A reference segment (C), whose lumen diameter is 3.2 mm, is shown for comparison. Coronary flow velocity signals at baseline and during hyperemia are shown in Panel C. The coronary flow reserve measured 1.0. Simultaneous phasic and mean aortic (Pa) and translesional pressure (Pd) obtained with a fiber optic pressure guidewire (Radi) are shown in Panel D. During intracoronary injection of 18 μg of adenosine the mean translesional gradient increased to 39 mm Hg. The myocardial fractional flow reserve measured 0.63. This patient was subsequently treated with stent placement. The angiographic results are shown in Panel E. The Annals of Thoracic Surgery 1999 68, 1547-1551DOI: (10.1016/S0003-4975(99)00960-1)

Fig 1 An asymptomatic 56-year-old female patient with normal left anterior descending and left circumflex arteries had in intermediate lesion in the “mid portion” of the right coronary artery. Quantitative coronary angiography of the lesion revealed a reference vessel diameter of 2.44 mm and a percent diameter stenosis of 52% (Panel A). Intravascular ultrasound imaging showed four “stenoses.” All four are shown relative to the coronary angiogram. The worst stenosis (A) has a minimum lumen area of 1.6 mm2 and a minimum lumen diameter of 1.1 mm. However, at least two others fit the IVUS criterion of significance (minimum lumen area less than 4.0 mm2): they are labeled (B) and (D). There is significant ostial disease (A) as well. A reference segment (C), whose lumen diameter is 3.2 mm, is shown for comparison. Coronary flow velocity signals at baseline and during hyperemia are shown in Panel C. The coronary flow reserve measured 1.0. Simultaneous phasic and mean aortic (Pa) and translesional pressure (Pd) obtained with a fiber optic pressure guidewire (Radi) are shown in Panel D. During intracoronary injection of 18 μg of adenosine the mean translesional gradient increased to 39 mm Hg. The myocardial fractional flow reserve measured 0.63. This patient was subsequently treated with stent placement. The angiographic results are shown in Panel E. The Annals of Thoracic Surgery 1999 68, 1547-1551DOI: (10.1016/S0003-4975(99)00960-1)