Case report of FFR for bifurcation Nanjing first hospital Nanjing heart center Yefei chenshaoliang

Evidence of FFR guided PCI For single lesion: DEFER study; For multivessel disease: FAME study; For bifurcation lesions using 1-stent technique: Koo BK, et al. Eur Heart J 2008; For bifurcation lesions using 2-stent technique: NO DATA NOW

How to define a bifurcation lesion? No matter which kind of classification of bifurcation lesions, imaging characteristics is basic and important. But is it enough? What’s the objective for us to treat bifurcation using 1- or 2-stent technique? Keep two branch patency with effective anterior flow for a long time.

A bifurcation of 1-stent technique case report MAY, m, 70ys Angina pectoris for over 1 mon Risk factors: EH, EL, DM Echo: EF 54%, LVDd 55mm

CAG result

Classification of the bifurcation From CAG, classification of LCX-OM is 1,1,0 or 1,1,1 But how about functional result and IVUS result?

FFR of LCX-OM bif LCX-OM LCX-PL Is that true of FFR for both MB and SB?

Pitfalls in FFR Measurement of Bifurcation Proximal MB lesion Distal MB lesion Distal SB lesion FFR MB including distal MB lesion and proximal MB lesion FFR SB including distal SB lesion and proximal MB lesion

Strategy for the bifurcation lesion only according to FFR result 1-stent strategy or 2- stent strategy? But from FFR result, we can not define the classification 1,1,1 or 1,1,0 or 1,0,0.

Strategy for the bifurcation is 1-stent technique

Last result-after kissing

Follow-up after 10 month

FFR result at follow-up LCX-OM LCX-PL

Case 2 report Male, 63yrs, Chest pain for 1 mon, Risk factors: smoking, HL DIA: UAP, EH

CAG result

After 2 stent implanted

FFR result before PCI FFR (LAD) FFR (D1) From the CAG and FFR result, it’s a true bifurcation lesion of medina classification 0,1,1

FFR result after PCI FFR (LAD) after stenting FFR (D1) after stenting FFR (LAD) after stenting

Follow up result after 6 mon

FFR follow-up after 6 mon FFR (LAD) FFR (D1)

Summary of 2 cases Maybe FFR is not good for classification of bifurcation lesions compared with imaging result such as angiogram or IVUS et al. FFR is suitable for forecasting outcome for bifurcation treatment in the future. We need randomized, multicenter, large sample size study for using FFR guided bifurcation PCI.

Thanks for your attention