title: Fractional flow reserve-guided percutaneous coronary intervention for an intermediate stenosis complicated by a coronary-to-pulmonary artery fistula.
abstract: A 65-year-old man was referred to our hospital following repetitive chest pain. Invasive coronary angiography showed an intermediate stenosis of the proximal left anterior descending artery (LAD), and a coronary fistula originating distal to the stenosis draining into the main pulmonary artery. To evaluate the functional abnormality arising from the stenosis and coronary steal due to the fistula, fractional flow reserve (FFR) was measured using a pressure wire with pullback recording. The FFR value was 0.74 at the distal LAD, 0.78 distal to the fistula, 0.81 proximal to the fistula (distal to the stenosis), and abruptly increased to 1.0 proximal to the stenosis. Based on these FFR results, percutaneous coronary intervention was performed to the stenosis. After stent placement, the FFR value improved to 0.87 at the distal LAD, and no abrupt pressure gradient was observed beyond the fistula and the stent. FFR-guided intervention with pullback pressure recording could be a useful and practical method to apply in cases with coronary stenosis complicated by coronary fistula in the same vessel.
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan. tuyosiito@gmail.com.
authors: Tsuyoshi
authors: T
authors: Ito
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors: Shunsuke
authors: S
authors: Murai
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors: Hiroshi
authors: H
authors: Fujita
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors: Tomomitsu
authors: T
authors: Tani
authors: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, 4678601, Japan.
authors: Nobuyuki
authors: N
authors: Ohte
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
keywords: Coronary artery stenosis; Coronary fistula; Fractional flow reserve; Functional evaluation
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