iFR variations during coronary angioplasty

Abstract

A fifty-five year-old hypertensive and former smoker male admitted with signs of typical chest pain, left bundle brunch block, and normal troponin levels. The angiography revealed 2-vessel, left circumflex and right coronary artery disease. The latter was treated with a stent and for the circumflex coronary artery an instantaneous wave-free ratio (iFR)-guided intervention was decided. Then, a second conventional guidewire was used for stabilization purposes. Figure 1A shows initial angiography (video 1 of the supplementary data), equalization of proximal and distal pressures (figure 1B and figure 2A), plain balloon angioplasty and iFR wedge pressure determination (figure 1C and figure 2D), angiographic result after balloon-angioplasty (figure 1D), iFR determination after balloon angioplasty (figure 1E and figure 2E,F), and final result (figure 1F, figure 2G,H and video 1 of the supplementary data).