Читать книгу Interventional Cardiology - Группа авторов - Страница 175

Once measurements have been made, a pullback is recommended to understand if the coronary artery disease has a diffuse, focal, or mixed pattern. This is readily performed by moving the pressure wire backwards by applying gentle traction to bring the sensor to the vessel osmium. The port on the manifold should remain closed while doing this. Pullback can be done using a NHPR or FFR. If measuring FFR, pullback is most easily done when using an intravenous infusion of adenosine. An alternative is to use intracoronary papaverine which achieves a prolonged hyperemic state; however, this agent has become less common in practice and is associated with torsades de pointes. Regadenoson has also proved to be helpful for single vessel assessment. It is less practical for pullback or multi‐vessel assessment, as the dose can be administered only once, and the duration of hyperemia is extremely variable between patients (30 to 120 seconds). In some cases, the hyperemic effect can be diminishing during the pullback, making the interpretation challenging.

The sensor should always be returned to the vessel ostium after assessment to exclude the presence of significant pressure‐wire or hemodynamic system drift which would make the measurement unreliable. Values of drift over 2 mmHg suggest the measurement should be repeated.