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Diagnosis of Coronary Artery Disease Supported by FFR Courtesy of Praveen Chandra, MD, Medanta The Medicity, Gurgaon, India In certain situations Fractional Flow Reserve (FFR) is a reliable tool for planning intervention easier and faster for assessing the severity of epicardial stenoses. Especially in situations such as borderline lesions, lesion with a distal vessel having competitive flow from collaterals and some eccentric lesions where in a few shots the lesion looks tighter or wider than reality. It has been shown that it is safe to defer an intervention in a single vessel disease patient when FFR > 0.80. On many occasions we took critical patients with deranged renal function, (elevated factors like Blood Urea and Creatinine) we reduce contrast load to the patient by cutting to fewer angio shots and decide on severity based on FFR. This cutting edge technology clearly identifies the patient that can be safely treated by medicines alone, and also avoids unnecessary angioplasty and bypass surgery in a reasonable number of cases. FFR is more dependable because FFR determines the ischemic severity of the block, specific to the particular block. It reduces extra procedures and time to wait for results, such as with stress thallium. In dealing with left main cases the decision between PTCA and CABG it helps a lot. Thus FFR supported us in making the right decision at the right time. The integrated FFR with Sensis Lite1 is the new tool incorporated in our new lab that simplifies workflow and displays the exact report, which helps us in faster decision making. This integration, unlike the other previous versions of FFR we had in our lab makes the workplace free of various pieces of equipment, allows use of the common user interface of Sensis Lite, fewer cables and less chance of an incorrect connection with improved efficiency. FFR also reduces the number of stents used on the patient thus reduces the risk Clinical angiogram images are considered one of the gold standards in diagnosing coronary artery diseases. Most of the time it allows us to make the right decision during coronary interventions, but in some cases the decision making is bit tough with angiography images. Praveen Chandra, MD, Chairman Division of Interventional Cardiology, Medanta The Medicity, Gurgaon, India frequently uses FFR for decision making to avoid unnecessary angioplasty and bypass surgery in a reasonable number of cases. and cost to the patient. Using FFR has improved the clinical outcome for patients, and deciding in favor of stent implantation is much simpler and evidence based, with better long-term outcomes than seen in other groups of patients. In MEDANTA we match the highest standards of healthcare delivery worldwide, and were the first in India to use integrated FFR with the Sensis Lite hemodynamic system. Our interventional cardiology team got this technology in an earlier lab as standalone system. We now have integrated FFR along with a recently acquired cath lab with Sensis Lite. So far our team has used FFR for 315 patients, 414 coronary arterial lesions that were border line in terms of angiographic criteria. In 255 lesions FFR was negative and in 159 lesions FFR was positive. 53 patients had angioplasty deferred in view of nonsignificant lesions, and in 16 patients CABG was planned instead of PCI in view of significant left main or TVD. A total of 199 stents were saved due to an insignificant lesion. In patients with multi-vessel disease, PCI of hemodynamically non-significant stenosis can be safely deferred, even if initially planned on the basis of the angiogram. “FFR supported us in making the right decision at the right time!” Praveen Chandra, MD Division of Interventional Cardiology, Medanta The Medicity, Gurgaon, India 1 This product is commercially not available in the US. Contact harish.gulhar@siemens.com Cardiology Fractional Flow Reserve 32  AXIOM Innovations | December 2013 | www.siemens.com/angiography


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