What are the causes of a suboptimal FFR after coronary stent deployment? Insights from a consecutive series using OCT imaging.

Journal article

Aims: Fractional flow reserve (FFR) can be used to detect a suboptimal result after percutaneous coronary intervention (PCI). A lower post-procedure FFR (<0.90) has been shown to be associated with adverse clinical outcomes at follow-up. This pilot study aimed to understand the mechanisms resulting in a suboptimal FFR and whether optical coherence tomography (OCT)-guided optimisation could improve final FFR.

Methods and results: Thirty-five patients undergoing complex PCI were prospectively enrolled. After stenting and post-dilatation, OCT and pressure wire were performed. An FFR threshold <0.90 after PCI was defined as suboptimal and mandated further PCI optimisation. A satisfactory post-PCI FFR (predefined as ≥0.90) was achieved immediately after conventional PCI in 14 patients (40%) and in this group no further treatment was performed. Minor abnormalities (stent malapposition of 200-500 µm) were observed with OCT in three of these patients. Suboptimal functional results after conventional stenting (predefined as an FFR <0.90) were found in 21 patients (60%). In thirteen out of these 21 patients (61.9%), OCT demonstrated a suboptimal stent result. Subsequent OCT-guided optimisation was performed resulting in a higher final FFR (increase from 0.80±0.02 to 0.88±0.01; p=0.008).

Conclusions: Despite a satisfactory angiographic result, a suboptimal functional result is evident in a substantial proportion of patients undergoing complex PCI. Implementation of an OCT-guided PCI optimisation protocol may reveal potentially treatable causes, allowing optimisation of the post-PCI functional result.

Authors: Wolfrum, M; De Maria, G; Benenati, S; Langrish, J; Lucking, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Europa Digital and Publishing
• Journal: EuroIntervention
• Volume: 14
• Issue: 12
• Pages: e1324-e1331
• Publication date: 2018-12-20
• Acceptance date: 2018-11-01
• DOI: 10.4244/eij-d-18-00071
• EISSN: 1969-6213
• ISSN: 1774-024X
• Pmid: 29784630
• Language: English
• Keywords: drug-eluting stent; fractional flow reserve; optical coherence tomography; stent enhancement