Fractional flow reserve for the assessment of complex multivessel disease in a patient after hybrid coronary revascularization.
We present a case of a 43-year-old woman with history of hybrid coronary revascularization [endoscopic atraumatic coronary artery bypass (ACAB)] of left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and stent implantation in right coronary artery (RCA), who presented 6 years later with recurrent atypical angina. Coronary angiography revealed patent LIMA to LAD and RCA stent, with a new lesion in an obtuse marginal artery and significant progression of disease in the proximal/mid LAD proximal to LIMA touchdown. To further evaluate the hemodynamic significance of these new disease segments, the patient underwent fractional flow reserve (FFR) assessment of the left coronary system with subsequent stent implantation in the proximal/mid LAD. This case illustrates (1) the critical value of FFR assessment in determining the ischemia provoking lesions in this post ACAB patient with complex multivessel coronary artery disease; and (2) the accelerated progression of atherosclerosis in bypassed segments as compared to segments proximal to stents.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Michel T
MT
Corban
Parham
P
Eshtehardi
Habib
H
Samady
D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D018450:Disease Progression; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011237:Predictive Value of Tests; D012008:Recurrence; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome