Читать книгу Interventional Cardiology - Группа авторов - Страница 180

With the advent of advanced computational systems it is now feasible for the pressure wire tip to be tracked during continuous fluoroscopy. This is facilitating co‐registration between pressure changes and angiographic disease and enable operators to move the wire freely (Figure 7.7). Continuous wire tracking obviates the need for specialized pullback devices and enables the operator to perform this manually at their own pace. The pressure data is placed upon the angiogram enabling easy manipulation for “virtual‐PCI”. Removing a stenosis can be performed by drawing directly onto the co‐registered angiogram image and allows advanced planning of coronary intervention. This can produce a predicted post‐PCI iFR value and operators can consider which stenting approach will achieve an optimal hemodynamic result while balancing risk of potentially complex coronary intervention (Figure 7.8).

Figure 7.7 Right coronary artery assessment with iFR pullback and SyncVision Co‐registration. This patient was found to have severe cardiac impairment with severe multi‐vessel disease. (a) The distal right coronary artery was assessed using minimal contrast due to renal impairment. (b) Physiological assessment provided greater spatial assessment and revealed the lesion in the distal PDA to be highly ischaemic with iFR 0.50. iFR‐Pullback demonstrated the majority of the pressure loss was localized to the PDA disease with modest pressure loss in the mid‐vessel. (c) Co‐registration could be performed without contrast to minimize the renal impact. Targeting the distal vessel would improve the intracoronary pressure loss.

Figure 7.8 Left anterior descending artery iFR pullback and SyncVision Co‐Registration. (a) This patient had an angiographically mild mid‐LAD stenosis. (b) iFR assessment demonstrated ischaemia with distal iFR 0.86. Co‐registered pullback demonstrated minor distal diffuse disease and pressure loss across the angiographic stenosis. Length measurement on co‐registration suggested a lesion of 27mm. Pullback analysis suggests that removing that lesion would yield an iFR of 0.94 in the vessel. (c) This was treated with a 3.5x26mm Drug eluting stent and this was optimized with non‐compliant balloons to ensure full expansion. (d) After intervention, the distal iFR was 0.91.