1. FFR et bifurcation

2. FFR et MB avant ATL MB SB ?

3. 1.Intermediate stenoses (Pijls et al. New Engl J Med 1996) (Pijls et al. JACC 2010) 2.Post-myocardial setting (De Bruyne et al Circulation 2001) (Ntalianis et al. JACCInterv 2010) 3.Multivessel Disease (Tonino et al. New Engl J Med 2009) 4.Left main stenosis (Hamilos, Muller et al. Circulation 2009) 5.Proximal LAD stenosis (Muller et al. JACCInterv 2011) The Value of FFR in terms of Clinical Outcome Has Been Validated in patients with

4. FFR et MB avant ATL MB SB Oui

5. FFR et SB avant ATL MB SB ?

6. Mach band in bifurcation

7. http://en.wikipedia.org/wiki/Lateral_inhibition "Mach bands are an optical illusion consisting of an image of two wide bands, one light and one dark, separated by a narrow strip with a light-to-dark gradient. The human eye perceives two narrow bands of different brightnesses either side of the gradient that are not present in the original image."optical illusionhuman eye Lateral Inhibition (or Mach band visual effect)

8. Mach band in bifurcation

10. FFR et SB avant ATL FFR overestimates the severity 1. 2. Jailing of a pressure wire between the stent and the vessel wall is not recommended Anatomical changes after MB stenting: carina shift, stent struts 3.

11. FFR et SB avant ATL MB SB Peu utile

12. FFR et MB après ATL MB SB ?

13. FFR et MB après ATL Pijls, Circulation 2002Samady, JACCinterv 2009 Pas d’interet

14. FFR et SB après ATL MB SB ?

15. FFR et SB après ATL 1.FFR-guided provisional SB intervention strategy is feasible and effective 2. Functional status of jailed SB lesions after DES implantation does not change significantly during follow-up Koo, European Heart Journal (2008)

16. FFR Basics for bifurcation BifurcationMBBefore PCIYESAfter PCI(YES)SBBefore PCI (YES and NO) After PCI YES (subset of lesions) FFR

17. Anatomically significant stenosis is frequently functionally insignificant Among side branch lesions > 75% stenosis after main vessel stenting, only 27% were functionally significant. (Pd/Pa) FFR P d P a = Koo BK, J Am Coll Cardiol 2005

18. FFR can tell what you have really done…… Before PCIAfter MB stentingAfter kissing balloon

19. M M Main prox. firstA A Main Accross side firstD D Distal firstS S Side branch first Extended V Skirt PM stenting MB stenting across SB MB stenting + kissing MB stenting + SB balloon Elective T stenting Internal crush CulotteTAP DM stenting Provisional SKS V stenting SKS Trouser legs and seat SB ostial stenting SB minicrush SB crush Syst. T Stenting MinicrushCrush After balloon 2 stents 3 stents 1 st stent Skirt + DM Skirt + SB Y. Louvard, CCI 2008;71(2):175-83. Provisional SB Stenting is The Gold Standard !