Figure:

Next to the angiographic image, visualization of the hemodynamics during the examination is shown. The red curve represents the aortic pressure, the red line the mean aortic pressure. The yellow curve represents the coronary artery pressure and the yellow line the mean coronary artery pressure.

a) Visually high-grade angiographic stenosis of a diagonal branch of the left anterior descending artery (LAD) (white arrow).

The fractional flow reserve (FFR)—determined by comparing the aortic pressure (red) and the mean coronary artery pressure distal to the stenosis (yellow) after adenosine administration—is 0.84. Thus, the stenosis is classified as not hemodynamically relevant, and consequently would not benefit from revascularization. The red arrow shows where the pressure sensor is located.

b) Visually moderate-stenosis of the LAD (white arrow).

The FFR—determined by comparing the aortic pressure (red) and the mean coronary artery pressure distal to the stenosis (yellow)—is 0.74. Thus, the stenosis is classified as hemodynamically relevant and the patient would benefit from revascularization. The red arrow shows where the pressure sensor is located.

c) High-grade stenosis of the LAD (large white arrow), followed by 2 non–high-grade stenoses in the middle-third of the artery (small white arrows). The FFR—determined by comparing the aortic pressure (red) and the mean coronary artery pressure distal to the stenosis (yellow)—is 0.64, indicating relevant ischemia. The red arrow shows where the pressure sensor is located.

d) The finding of Figure c immediately after percutaneous coronary intervention (PCI) of the proximal stenosis with placement of a drug eluting stent (large white arrow). The FFR is now 0.91. Thus, the residual stenoses (small white arrows) are not hemodynamically relevant. The red arrow shows where the pressure sensor is located.