Assessment of intermediate severity coronary lesions in the catheterization laboratory

被引:229
作者
Tobis, Jonathan [1 ]
Azarbal, Babak [1 ]
Slavin, Leo [1 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Adult Cardiac Catheterizat Lab, Ctr Hlth Sci BL394,Dept Med,Div Cardiol, Los Angeles, CA 90095 USA
关键词
D O I
10.1016/j.jacc.2006.10.055
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The management of intermediate coronary lesions, defined by a diameter stenosis of 40% to 70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Intravascular ultrasound (IVUS) and fractional flow reserve index (FFR) provide anatomic and functional information that can be used in the catheterization laboratory to designate patients to the most appropriate therapy. The purpose of this review is to discuss the critical information obtained from IVUS and FFR in guiding treatment of patients with intermediate coronary lesions. In addition, the importance of IVUS and FFR in the management of patients with serial stenosis, bifurcation lesions, left main disease, saphenous vein graft disease, and acute coronary syndrome will be discussed.
引用
收藏
页码:839 / 848
页数:10
相关论文
共 113 条
[1]   Clinical, intravascular ultrasound, and quantitative angiographic determinants of the coronary flow reserve before and after percutaneous transluminal coronary angioplasty [J].
Abizaid, A ;
Mintz, GS ;
Pichard, AD ;
Kent, KM ;
Satler, LF ;
Walsh, CL ;
Popma, JJ ;
Leon, MB .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 82 (04) :423-428
[2]   One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms [J].
Abizaid, AS ;
Mintz, GS ;
Abizaid, A ;
Mehran, R ;
Lansky, AJ ;
Pichard, AD ;
Satler, LF ;
Wu, HS ;
Kent, KM ;
Leon, MB .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 34 (03) :707-715
[3]   Retinopathy identifies marked restriction of coronary flow reserve in patients with diabetes mellitus [J].
Akasaka, T ;
Yoshida, K ;
Hozumi, T ;
Takagi, T ;
Kaji, S ;
Kawamoto, T ;
Morioka, S ;
Yoshikawa, J .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (04) :935-941
[4]   Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions [J].
Al Suwaidi, J ;
Berger, PB ;
Rihal, CS ;
Garratt, KN ;
Bell, MR ;
Ting, HH ;
Bresnahan, JF ;
Grill, DE ;
Holmes, DR .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (04) :929-936
[5]   CORONARY-ARTERY NARROWING IN CORONARY HEART-DISEASE - COMPARISON OF CINEANGIOGRAPHIC AND NECROPSY FINDINGS [J].
ARNETT, EN ;
ISNER, JM ;
REDWOOD, DR ;
KENT, KM ;
BAKER, WP ;
ACKERSTEIN, H ;
ROBERTS, WC .
ANNALS OF INTERNAL MEDICINE, 1979, 91 (03) :350-356
[6]   Effects of dobutamine on coronary stenosis physiology and morphology - Comparison with intracoronary adenosine [J].
Bartunek, J ;
Wijns, W ;
Heyndrickx, GR ;
de Bruyne, B .
CIRCULATION, 1999, 100 (03) :243-249
[7]   Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis - A randomized trial [J].
Bech, GJW ;
De Bruyne, S ;
Pijls, NHJ ;
de Muinck, ED ;
Hoorntje, JC ;
Escaned, J ;
Stella, PR ;
Boersma, E ;
Bartunek, J ;
Koolen, JJ ;
Wijns, W .
CIRCULATION, 2001, 103 (24) :2928-2934
[8]   Long-term follow-up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measurement [J].
Bech, GJW ;
De Bruyne, B ;
Bonnier, HJRM ;
Bartunek, J ;
Wijns, W ;
Peels, K ;
Heyndrickx, GR ;
Koolen, JJ ;
Pijls, NHJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 31 (04) :841-847
[9]   Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty [J].
Bech, GJW ;
Pijls, NHJ ;
De Bruyne, B ;
Peels, KH ;
Michels, HR ;
Bonnier, HJRM ;
Koolen, JJ .
CIRCULATION, 1999, 99 (07) :883-888
[10]   Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease [J].
Bech, GJW ;
Droste, H ;
Pijls, NHJ ;
De Bruyne, B ;
Bonnier, JJRM ;
Michels, HR ;
Peels, KH ;
Koolen, JJ .
HEART, 2001, 86 (05) :547-552