Microcatheter-versus wire-based measurement of the fractional flow reserve.

Fractional flow reserve; coronary artery physiology; crossing profile; microcatheter; non-hyperaemic pressure ratio; pressure wire; Cardiology and Cardiovascular Medicine; General Medicine

Abstract :

[en] BACKGROUND: Fractional flow reserve (FFR) guided-percutaneous interventions is nowadays the gold standard for optimal coronary artery revascularization. While multiple pressure guidewires have been validated, the use of microcatheter for FFR measurements is still a matter of debate. OBJECTIVE: The aim of this study was to investigate the crossing profile characteristics of the NAVVUS® microcatheter as compared with the COMETTM pressure wire. At the same time, we compared non-hyperaemic pressure ratio (NHPR) and FFR measurements of both systems. METHOD/MATERIALS: In this retrospective study, all angiographically intermediate coronary artery stenoses each month were assessed, using either the NAVVUS® or the COMETTM pressure system, to receive coronary artery physiology assessment with NHPR and FFR measurements. The crossing profile of both systems was compared regarding objective coronary artery lesion characteristics using quantitative coronary analysis evaluation. RESULTS: Over a period of 4.5 years, we evaluated 213 coronary artery stenoses using one of the two coronary tools. We found a 9.2% crossing profile failure rate using the microcatheter, compared to 0.7% in the pressure wire group (p < .001). The crossing failure was significantly correlated with the presence of coronary artery calcifications and angulation (p = .042, p = .049, respectively). FFR values were comparable be- tween the two groups and were significantly lower in the presence of coronary calcifications and proportional to the degree of stenosis (p = .036, p = .010). Pressure drift was comparable. CONCLUSION: Our observations are in line with other studies reporting the poor crossing profile of the NAVVUS® microcatheter. NHPR and FFR measures of both systems were well correlated.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Boutaleb, Amine Mamoun ; Cardiology, Ibn Rochd University Hospital, Casablanca, Morocco

Scalia, Alessandro ; Université de Mons - UMONS > Faculté de Médecine et de Pharmac > Service de Cardiologie ; CHU Ambroise Paré, Mons, Belgium

Ghafari, Chadi ; Université de Mons - UMONS > Faculté de Médecine et de Pharmacie > Service de Cardiologie

Carlier, Stéphane ; Université de Mons - UMONS > Faculté de Médecine et de Pharmac > Service de Cardiologie

Language :

English

Title :

Microcatheter-versus wire-based measurement of the fractional flow reserve.

Publication date :

November 2023

Journal title :

Acta Cardiologica

ISSN :

0001-5385

eISSN :

1784-973X

Publisher :

Taylor and Francis Ltd., England

Volume :

Issue :

Pages :

1024 - 1032

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://www.tandfonline.com/doi/pdf/10.1080/00015385.2023.2246009

Research unit :

M106 - Cardiologie

Research institute :

R550 - Institut des Sciences et Technologies de la Santé

Funding text :

This work is non-funded by any industry or potential actor. I would like to express my special thanks to the Free University of Brussels, to the Faculty of Medicine of Hassan II University and to Professor Carlier for having given me the opportunity, via the FOSFOM fellowship program, to complete a one-year internship at the University Hospital of Ambroise Pare, in Mons, Belgium. I would also like to recognise all of those who have directly and indirectly helped in treating these patients and guided me in writing this study.

Available on ORBi UMONS :

since 14 January 2024

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Bibliography

van de Hoef TP, Nolte F, Rolandi MC, et al. Coronary pressure-flow relations as basis for the understanding of coronary physiology. J Mol Cell Cardiol. 2012; 52 (4): 786–793. doi: 10.1016/j.yjmcc.2011.07.025.
Pijls NH, van Son JA, Kirkeeide RL, et al. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993; 87 (4): 1354–1367. doi: 10.1161/01.cir.87.4.1354.
Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996; 334 (26): 1703–1708. doi: 10.1056/NEJM199606273342604.
Neumann F-J, Sousa-Uva M, Ahlsson A, et al. ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019; 40 (2): 87–165. doi: 10.1093/eurheartj/ehy394.
Hamilos M, Muller O, Cuisset T, et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation. 2009; 120 (15): 1505–1512. doi: 10.1161/CIRCULATIONAHA.109.850073.
Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009; 360 (3): 213–224. doi: 10.1056/NEJMoa0807611.
Kayaert P, Coeman M, Gevaert S, et al. Physiology-based revascularization of left main coronary artery disease. J Intervent Cardiol. 2021; 2021: 1–16. doi: 10.1155/2021/4218769.
Sen S, Escaned J, Malik IS, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis. J Am Coll Cardiol. 2012; 59 (15): 1392–1402. doi: 10.1016/j.jacc.2011.11.003.
Scarsini R, Pesarini G, Lunardi M, et al. Observations from a real-time, iFR-FFR “hybrid approach” in patients with severe aortic stenosis and coronary artery disease undergoing TAVI. Cardiovasc Revasc Med. 2018; 19 (3 Pt B): 355–359. doi: 10.1016/j.carrev.2017.09.019.
Pijls NHJ, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis. J Am Coll Cardiol. 2007; 49 (21): 2105–2111. doi: 10.1016/j.jacc.2007.01.087.
De Bruyne B, Pijls NHJ, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367 (11): 991–1001. doi: 10.1056/NEJMoa1205361.
Collet J-P, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021; 42 (14): 1289–1367. doi: 10.1093/eurheartj/ehaa575.
Van’t Veer M, Pijls NHJ, Hennigan B, et al. Comparison of different diastolic resting indexes to iFR. J Am Coll Cardiol. 2017; 70 (25): 3088–3096. doi: 10.1016/j.jacc.2017.10.066.
Götberg M, Christiansen EH, Gudmundsdottir IJ, et al. Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med. 2017; 376 (19): 1813–1823. doi: 10.1056/NEJMoa1616540.
Davies JE, Sen S, Dehbi H-M, et al. Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med. 2017; 376 (19): 1824–1834. doi: 10.1056/NEJMoa1700445.
Michail M, Thakur U, Mehta O. Non-hyperaemic pressure ratios to guide percutaneous coronary intervention. Open Heart. 2020; 7: 1308–1308. doi: 10.1136/openhrt-2020-001308.
Yong A, Daniels D, Bruyne D, et al. Fractional flow reserve assessment of left main stenosis in the presence of downstream coronary stenoses. Circ Cardiovasc Interv. 2013; 6 (2): 161–165. doi: 10.1161/CIRCINTERVENTIONS.112.000104.
De Bruyne B, Pijls NH, Heyndrickx GR, et al. Pressure-derived fractional flow reserve to assess serial epicardial stenoses: theoretical basis and animal validation. Circulation. 2000; 101 (15): 1840–1847. doi: 10.1161/01.cir.101.15.1840.
Masdjedi K, Van Mieghem NM, Diletti R, et al. Navvus FFR to reduce CONTRAst, cost and radiaTion (CONTRACT); insights from a single-centre clinical and economical evaluation with the RXi rapid-exchange FFR device. Int J Cardiol. 2017; 233: 80–84. doi: 10.1016/j.ijcard.2017.01.019.
Menon M, Jaffe W, Watson T, et al. Assessment of coronary fractional flow reserve using a monorail pressure catheter: the first-in-human ACCESS-NZ trial. EuroIntervention. 2015; 11 (3): 257–263. doi: 10.4244/EIJV11I3A51.
Diletti R, Van Mieghem NM, Valgimigli M, et al. Rapid exchange ultra-thin microcatheter using fibre-optic sensing technology for measurement of intracoronary fractional flow reserve. EuroIntervention. 2015; 11 (4): 428–432. doi: 10.4244/EIJY15M05_09.
Fearon WF, Chambers JW, Seto AH, et al. ACIST-FFR Study (Assessment of Catheter-Based Interrogation and Standard Techniques for Fractional Flow Reserve Measurement). Circ Cardiovasc Interv. 2017;10(12):e005905. doi: 10.1161/CIRCINTERVENTIONS.117.005905.
Bommel RJV, Masdjedi K, Diletti R. Routine fractional flow reserve measurement after percutaneous coronary intervention: the FFR-SEARCH study. Circ Cardiovasc Interv. 2019; 12: 7428–7428.
Pouillot C, Fournier S, Glasenapp J, et al. Pressure wire versus microcatheter for FFR measurement: a head-to-head comparison. EuroIntervention. 2018; 13 (15): e1850–e1856. doi: 10.4244/EIJ-D-17-00238.
Seligman H, Shun-Shin MJ, Vasireddy A, et al. Fractional flow reserve derived from micro- catheters versus standard pressure wires: a stenosis-level meta-analysis. Open Heart. 2019; 6 (1): e000971. doi: 10.1136/openhrt-2018-000971.
Boutaleb AM, Ghafari C, Ungureanu C, et al. Fractional flow reserve and non-hyperemic indices: essential tools for percutaneous coronary interventions. World J Clin Cases. 2023; 11 (10): 2123–2139. doi: 10.12998/wjcc.v11.i10.2123.
Fearon WF, Zimmermann FM, Bruyne D, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022; 386 (2): 128–137. doi: 10.1056/NEJMoa2112299.
Stables RH, Mullen LJ, Elguindy M, et al. Routine pressure wire assessment versus conventional angiography in the management of patients with coronary artery disease: the RIPCORD 2 trial. Circulation. 2022; 146 (9): 687–698. doi: 10.1161/CIRCULATIONAHA.121.057793.
Rioufol G, Dérimay F, Roubille F, et al. Fractional flow reserve to guide treatment of patients with multivessel coronary artery disease. J Am Coll Cardiol. 2021; 78 (19): 1875–1885. doi: 10.1016/j.jacc.2021.08.061.
Puymirat E, Cayla G, Simon T, et al. Multivessel PCI guided by FFR or angiography for myocardial infarction. N Engl J Med. 2021; 385 (4): 297–308. doi: 10.1056/NEJMoa2104650.
Xu B, Tu S, Song L, et al. Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial. Lancet. 2021; 398 (10317): 2149–2159. doi: 10.1016/S0140-6736(21)02248-0.
Wang L, Travieso A, van der Hoeven N, et al. Improved nonculprit stenosis assessment in patients with ST-segment elevation myocardial infarction using quantitative flow ratio. JACC Cardiovasc Interv. 2023; 16 (14): 1828–1830. doi: 10.1016/j.jcin.2023.04.045.