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Fractional flow reserve for the assessment of complex multivessel disease in a patient after hybrid coronary revascularization
Author(s) -
Corban Michel T.,
Eshtehardi Parham,
Samady Habib
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24605
Subject(s) - fractional flow reserve , medicine , cardiology , revascularization , coronary artery disease , stent , angina , right coronary artery , artery , coronary flow reserve , hemodynamics , radiology , coronary angiography , myocardial infarction
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. © 2012 Wiley Periodicals, Inc.