12.1 Manual of PCI - Coronary physiology

Coronary physiology is performed in order to: (a) assess the hemodynamic significance of native coronary lesion and determine the need for PCI; and (b) to assess whether an optimal result was achieved after PCI.
Both hyperemic (usually adenosine FFR) and non-hyperemic indices (such as iFR, dPR, RFR) can be used, with non-hyperemic indices used more commonly as they are easier to perform.
Coronary physiologic assessment is performed in 8 steps, as follows:
1. Flush + zero pressure wire
2. Insert pressure to tip of guide
3. Remove introducer, flush guide with NS, equalize pressures
4. Advance pressure wire distal to the target lesion
5. Measure resting physiologic index
6. Measure hyperemic FFR (if needed)
7. Pullback
8. Check for drift

[@1kamais]

Great educational clip. I really appreciate you Dr. Brilakis. I’ve learnt a great deal from you.

[@matheuscsmed]

Thank you, Matheus Silva

[@shangz0216]

Thanks for your educative sharing.

[@areenal-taie6836]

Excellent learning video, thank you very much

[@tom11298]

excellent presentation

[@hazemalbareda1872]

thanks a lot , great short ,conclusive presentation
in our center we are doing ffr by ic adenosine is there significant difference between ic and iv infusion adenosine results ? check draft can be done for ifr and pd/pa and replace draft for ffr?

[@deriarara376]

thank you so much

[@praveenalane4331]

Thank you professor

[@MrAymano1]

Thanks!!

[@llacielona]

Thank you so much for the effort that you put and all the great presentations! There are some cases when iFR ist >0,9 at normal conditions, but falls below 0,9 meaning it becomes pathologic after contrast injection. What do you do with those cases, particularly if patients do have angina, put a stent or leave them alone?

[@manosbrilakis]

Contrast is a vasodilator (contrast FFR) - the cutoff for significance for contrast FFR is 0.83.

[@salahuddinsalahuddin3210]

Thank you. Just one additional question: what kind of guide catheter can we use? With side holes, without or both?

[@salahuddinsalahuddin3210]

Thanks.

[@herminingsih66]

thank you professor for such a clear and very informative educational video