Functional coronary angiography to assess epicardial vessels and the microcirculation

SUMMARY

While the use of intracoronary pressure guidewires is currently recommended in clinical practice guidelines to assess functional stenosis relevance and the status of the microcirculation, adoption of functional coronary assessment remains being suboptimal. New developments in wire-free functional coronary assessment derived from the angiogram, globally termed as functional coronary angiography (FCA), may contribute to a more widespread use of physiology to diagnose the cause of ischemia and to plan and guide coronary revascularisation. In this chapter, we will revisit the principles and technical aspects of FCA, with a specific focus on techniques using invasive coronary angiography (ICA). Clinical applicability of FCA in specific clinical scenarios is also discussed.

Introduction

Coronary angiography remains the most frequently utilised tool to plan and guide myocardial revascularisation, despite a large body of evidence highlighting its limitations in assessing functional relevance of coronary stenoses when used in isolation, particularly in cases of intermediate angiographic severity 11. Marcus ML, Skorton DJ, Johnson MR, Collins SM, Harrison DG, Kerber RE. Visual estimates of percent diameter coronary stenosis: A battered gold standard. J Am Coll Cardiol. 1988;11(4):882-885. Link. The development of fractional flow reserve (FFR), a pressure-derived physiologic index, and its use in guiding...