How to prevent unnecessary coronary interventions: identifying lesions responsible for ischemia in the cath lab.
OBJECTIVE
Coronary angiography is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In the catheterization laboratory three techniques can be used for the evaluation of the physiologic significance of intermediate or borderline significant coronary stenoses: (1) pressure wire-derived coronary fractional flow reserve (FFR), (2) Doppler wire-derived measurement of coronary flow reserve (CFR), and (3) intravascular ultrasound (IVUS).


RESULTS
All of these techniques have been validated for assessing the functional significance of intermediate stenoses, but also have inherent limitations.


CONCLUSIONS
Overall, measurement of FFR appears to be the best method for interrogating intermediate coronary lesions. This review discusses the strengths and limitations of each of these techniques.
Aude
Y Wady
YW
Department of Internal Medicine, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock 72205-7199, USA. audeyamilw@uams.edu
Garza
Luis
L
D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000706:statistics & numerical data; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D012039:Regional Blood Flow; D018084:Ultrasonography, Interventional / Q000379:methods*; D019564:Unnecessary Procedures