title: [Diffuse atherosclerotic disease unmasked by invasive physiologic assessment of coronary flow].
abstract: It is known that coronary atherosclerosis is a diffuse process, very little visible at angiography. This article describes a stable angina patient, three months after acute myocardial infarction (AMI), and a severe lesion in anterior descending artery (ADA), evinced by coronariography. Myocardial fractional flow reserve (FFR), obtained through intracoronary pressure measurements, was 0.37 during maximum hyperemia, clearly showing the presence of ischemia. A stent was implanted in ADA and, despite the excellent angiographic result, post-stent FFR was only 0.75, the minimum limit, below which there is ischemia. When the pressure wire (PW) was slowly drawn back from the distal portion of ADA to its proximal portion, a continuous and gradual increase in intracoronary pressure was noted, which clearly indicates diffuse atherosclerosis and not focal stenosis. A gradient was not observed at the stent place. The patient was kept under medical treatment and has been asymptomatic so far.
authors.affiliation: Santa Helena Hospital do Coração, Cabo Frio, RJ. fernandomendes@cardiol.br
authors.forename: Fernando Mendes
authors.initials: FM
authors.lastname: Sant'Anna
authors.forename: Expedito E Ribeiro da
authors.initials: EE
authors.lastname: Silva
authors.forename: Leonardo Alves
authors.initials: LA
authors.lastname: Batista
authors.forename: Fábio Machado
authors.initials: FM
authors.lastname: Ventura
authors.forename: Carlos Alberto Mussel
authors.initials: CA
authors.lastname: Barrozo
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002932:Cineangiography; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects