title: Assessment of stent edge dissections by fractional flow reserve.
abstract: BACKGROUND
  Edge dissections after intervention have been studied with imaging techniques, however, functional assessment has not been studied yet. We investigated the relationship between fractional flow reserve (FFR) and the angiographic type of stent edge dissections and tried to assess the use of FFR-guided management for edge dissection.
  
  
  METHODS
  51 edge dissections assessed by FFR were included in this prospective observational study. FFR was measured for each type of edge dissection and compared with quantitative coronary angiographic findings. Clinical outcomes were evaluated based on FFR measurements.
  
  
  RESULTS
  Edge dissections were classified as type A (47.1%; 24/51), type B (41.2%; 21/51), type C (2.0%; 1/51) and type D (9.8%; 5/51). Mean FFR in type A dissection was 0.87 ± 0.09, in type B 0.86 ± 0.07, in type C 0.72 and in type D 0.57 ± 0.08. All type C and D dissections (6/51) had FFR ≤ 0.8 and were treated with additional stents. Among the 45 type A and B dissections, 8 had a FFR ≤ 0.8 (17.8%), and 50% received additional stenting. All dissections with FFR >0.8 were left untreated except one long dissection case. There was no death, myocardial infarction or target lesion revascularization during hospitalization or the follow-up period (median 152 days; IQR 42-352 days).
  
  
  CONCLUSIONS
  FFR correlates well with an angiographic type of edge dissection. Angiographic findings are sufficient for deciding the treatment of severe dissections such as types C and D, while FFR-guided management may be safe and effective for mild edge dissections such as types A and B.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Ju-Hyun
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Soe Hee
authors.initials: SH
authors.lastname: Ann
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Department of Internal Medicine, Keimyung University College of Medicine, Dongsan Medical Center, Daegu, South Korea.
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.affiliation: Division of Cardiology, Inje University Ilsan Paik Hospital, South Korea.
authors.forename: Joon-Hyung
authors.initials: JH
authors.lastname: Doh
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Gillian Balbir
authors.initials: GB
authors.lastname: Singh
authors.affiliation: Suntech Research Center, Seoul, South Korea.
authors.forename: Hyung Il
authors.initials: HI
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. Electronic address: sesim1989@gmail.com.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Shin
mesh_terms: D001013:Aorta, Thoracic / Q000293:injuries; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000293:injuries; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D057772:Vascular System Injuries / Q000175:diagnosis*
keywords: Drug eluting stent; Fractional flow reserve; Stent edge dissection