Dr. Say Sen, Imperial College Healthcare (London, UK), discusses a specific case where the use of iFR Co-registration changed his initial angio-based strategy. The ability to guide his PCI and assess the success of the treatment with the resolution of the ischemia, proves value to his patient and practice.
I'd like to share a few cases where I fr co registration has changed my practice. The first cases of a 65 year old gentleman with exertion, all chest pain and a positive exercise test had a coronary angiogram which is highlighted here. The left system was unobstructed. On the screen. You can see the right coronary artery which has moderate proximal disease with further severe distal disease leading into the P. L. V. And P. D. A. Branch. We were unclear whether or not we wanted to treat the proximal segment of this vessel but were very clear in our minds by looking at the angiogram that we had to treat the distal lesion from the main branch into the P. L. V. In order to guide our intervention, as we routinely do at the Hammersmith. We used I. F. RK registration. We passed the I. Fire wire down to the distal vessel and we found that the eye far in the P. L. V. Branch was in fact 0.93. This is obviously very surprising. It's just that neither of the two lesions that we've interrogated on this assessment were flow limiting. However, clearly the patient has symptoms of angina and he had a positive exercise test. You will note on this still on the image that there is a significant legion in what appears to be a small P. D. A vessel. We there fore took the opportunity to pass the I fire wire into this small P. D. A vessel. What you can see here is a significant value of point T. one. So rather than stenting from the main vessel into the P. D. A. R. Approach to this patient's coronary anatomy and intervention was now to be stenting from the main vessel into the P. D. A vessel. The procedure was performed using two wives and I won't bore you with the technical details how surprised to performing the procedure. We tried to identify where most of the human dynamic pressure loss was. And you can see here on this pullback very clearly that the pressure loss was in a focal area. We used I. F. R. Co. Registration. Furthermore, we found that all the pressure loss was associated with that severe hostile lesion into the P. D. A. As I said, the procedure was done using standard techniques. A provisional stent was placed from the main vessel into the P. D. A. With balloon dilatation at the end to open up the stent struts into the P. L. V. Branch in order to ensure good hemo dynamic result from our intervention. We repeated the dynamics and I fr assessment when we passed the eye far wire into the vessel. As you can see here, we can see an I. F. R. Value of 0.96 suggesting complete resolution of the hemo dynamic loss from the hostel stenosis. Furthermore, it also allowed us to determine that the proximal lesion was actually not him. A dynamically significant. So in summary I. F. RK registration here has completely changed our approach to intervention. This gentleman's right coronary artery and really is an example of how I fr co registration is not only guiding us onto which vessels in which lesions to intervene, but also how to intervene in daily interventional practice.