speaker's name: barry hennigan ☑ speaker for volcano corp today
DESCRIPTION
“How Coronary Flow Reserve Changed My Management ” Case Presentatio n Dr Barry Hennigan Professor Keith Oldroyd Interventional Cardiology Department West of Scotland Regional Heart and Lung Centre. Potential conflicts of interest. Speaker's name: Barry Hennigan - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/1.jpg)
“How Coronary Flow Reserve Changed My Management”Case PresentationDr Barry Hennigan
Professor Keith OldroydInterventional Cardiology Department
West of Scotland Regional Heart and Lung Centre
![Page 2: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/2.jpg)
Speaker's name: Barry Hennigan
☑ Speaker for Volcano Corp today
Potential conflicts of interest
![Page 3: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/3.jpg)
Patient MW• 65 year old man
• Presented July 2013
• CCS2 angina
• CABG Feb 1st 2011
• LIMA to LAD Heavily calcified proximal lesion (failed PCI)
• SVG to OM- (poor surgical target noted intra-op)
![Page 4: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/4.jpg)
Hx continued
• T2DM
• Obesity BMI 39
• HTN
• Hyperlipidemia
• Echo - mild Ant HK with good LV fx
![Page 5: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/5.jpg)
July 2013
• RAO RCALAO RCA
![Page 6: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/6.jpg)
July 2013
• LAO Cranial LIMA to LAD RCA Caudal LIMA to LAD
![Page 7: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/7.jpg)
Angiogram July 2013• LAO Caudal LCX LAO Cranial LCX
![Page 8: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/8.jpg)
Angiogram July 2013 Summary
• Heavily calcified proximal LCX • Occluded SVG to OM
• Patent LIMA to LAD
• Patent native RCA
• Medical therapy advised
![Page 9: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/9.jpg)
Clinical Course Nov 13-March 14
• Ongoing exertional chest pain
• Interfering with ability to run business
• On oral nitrate, ca++ channel blocker and BB
• Keen for intervention
![Page 10: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/10.jpg)
? Evidence of Ischemia
• DSE-suboptimal image quality due to BMI
• Daycase FFR +/- PCI to LCX
![Page 11: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/11.jpg)
March 2014
• PA Caudal RAO Caudal
![Page 12: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/12.jpg)
Combowire Assessment
![Page 13: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/13.jpg)
Combowire Design
![Page 14: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/14.jpg)
Case: Resting Perfusion
![Page 15: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/15.jpg)
Case: Hyperemic Perfusion
![Page 16: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/16.jpg)
Dilemma
• Normal FFR• Abnormal CFR• Ongoing symptoms• Single probable ischemic territory
• ? Optimal treatment
![Page 17: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/17.jpg)
PCI
•Predilated with a 3.0 sprinter to 18 atm
•Stented with a 4.0 by 18mm biomatrix to 14 atm•Post dilated 4.0 NC
![Page 18: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/18.jpg)
Hyperemic Perfusion Post PCI
![Page 19: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/19.jpg)
Clinical Progress
• Painfree• Back running business• Walking 1 mile without
symptoms• Exertional SOB on hills only• Actively losing weight• Completed further cardiac
rehab course
![Page 20: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/20.jpg)
Case Summary
• Discordant FFR/CFR results• ?causes – increased microvascular resistance• Convincing clinical scenario for ischemia• Single identifiable culprit territory• Excellent improvement in flow post
intervention
![Page 21: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/21.jpg)
Relationship between FFR CFR
Johnson et al. J Am Coll Cardiol Img. 2012;5(2):193-202
![Page 22: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/22.jpg)
Reasons for Discordant FFRwhere FFR>0.75 but CFR<2
• Diffuse microvascular disease • Previous infarcted territory• Distal stenosis
![Page 23: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/23.jpg)
Influencing Factors on CFR
- Preload- Afterload- Contractility- Hypertension- Diabetes mellitus- Cardiomyopathy- Age- LVH- Recent MI
![Page 24: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/24.jpg)
Thermodilution Versus Doppler
• Tmnhyperaemic/Tmnrest ratio
• Thermodilution may overestimate CFR
• Mean values• IMR calculation
rather than HMR• Good correlation
with doppler
• Uses APVH/APVB• In good hands
>90% success in achieving good doppler signal
• Learning curve
European Heart Journal (2004) 25, 219–223
![Page 25: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/25.jpg)
Thermodilution vs Doppler ctd
European Heart Journal (2004) 25, 219–223
![Page 26: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/26.jpg)
TIPS
• Anterograde vs retrograde• Positioning- use audio cues• Use sidebranches• Know your console• Wire handling- avoid trauma to tip• Experienced Operator• Don’t give up
![Page 27: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/27.jpg)
Conclusion• Would we recommend this approach routinely?• No• Flow does add useful information • New wire technologies enable easier + rapid
complementary dataset acquisition that improve decision making
• Supplements pressure data• Should be interpreted carefully with attention to
clinical scenario• Further validation in RCTs awaited
![Page 28: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/28.jpg)
Thank You Thank You
![Page 29: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/29.jpg)
![Page 30: Speaker's name: Barry Hennigan ☑ Speaker for Volcano Corp today](https://reader036.vdocuments.us/reader036/viewer/2022081519/56813a3d550346895da2271e/html5/thumbnails/30.jpg)
Defer if CFR>2