Conference chairman: Prof. Guo Lijun, Prof. Liu Jinghua, Prof. Qu Peng, Prof. Wang Weimin

Discussion guests: Prof. Jin Zening, Prof. Liu Xuebo, Prof. Liu Zhaoping, Prof. Tang Qiang, Prof. Zhang Jun

Demonstration guests: Prof. Li Jianping, Prof. Zheng Bo

In the live broadcast of CCIF2020 online surgery on April 21st, 2020, Professor Li Jianping from Peking University First Hospital successfully completed a difficult operation. It is worth mentioning that when selecting treatment for patients, Professor Li Jianping referred to functional (caFFR) evaluation and imaging (OCT) evaluation and finally determined the intervention plan based on the functional data provided by caFFR.

The patient is a 52-year-old man. Angiography showed a diffused stenosis and tortuous artery was detected: 95% stenosis in LAD, 95% stenosis in First Diagonal Branch (D1) and 99% stenosis in LCX. As the LCX has sufficient collateral circulation, intervention was not performed. In order to further determine the treatment strategy, Professor Li Jianping applied caFFR without pressure guidewire and vasodilator for functional evaluation. The FFR of LAD was 0.74 and the FFR of Diagonal Branch was 0.63. Since the FFR value of both vessels is less than 0.75, therefore, the revascularization was performed.

Coronary angiography revealed severe diffused lesion and tortuous artery

The FFR of LAD was 0.74

The FFR of Diagonal Branch was 0.63

Based on the patient's imaging and functional data, Prof. Li Jinaping decided to perform percutaneous coronary intervention for LAD and Diagonal branch lesion. He implanted a 3.0mm * 34mm stent and a 4.0mm * 26mm stent at the distal and proximal of LAD respectively. A 3.0mm*33mm post-dilatation balloon was ambulated in the diagonal branch and 3.0mm in the main branch.

The angiogram shows a significant improvement in blood flow after stent implantation

OCT showed the stent is well apposed.

After stent implantation, caFFR was performed and the diagonal branch FFR value was 0.95, and the distal proximal FFR value of the LAD was 0.91. Functional evaluation showed that the surgery effect was satisfactory and it was a complete success.

caFFR showed the FFR of Diagonal Branch was 0.95

caFFR showed the FFR in distal and proximal LAD was 0.91

The experts who attended the remote meeting to watch the live broadcast of the operation discussed with Prof. Li Jianping's team about the combination of imaging evaluation and functional evaluation to assist in the development of PCI strategies. The experts attending the meeting said that functional and imaging evaluation should be carried out at the same time for patients when conditions permit. If conditions are limited, priority should be given to functional evaluation, because functional evaluation can accurately determine whether the blood supply to the heart is adequate. In particular, caFFR can determine the FFR value of different section of multiple lesions at one time, which has important clinical value.

At present, FFR is more and more widely used. Professor Qu Peng from the Second Hospital of Dalian Medical University in Liaoning Province pointed out that if the post-stenting pressure wire-based FFR is measured in this case, the distance of the lesion was very long due to the calcified tortuosity of the vessel and the diffuse lesion. Coupled with the fact that the guidewire had a certain degree of stiffness, which inevitably stimulates vasoconstriction and therefore it would overestimate the degree of stenosis. After the introduction of domestic caFFR, due to the advanced technology, the FFR value of diffused lesions and vascular calcification can be obtained without a coronary pressure wire. The caFFR overcomes the shortcomings of FFR, including time consuming, hyperemic agents necessary to measure FFR, complication procedure and big expense etc., and therefore increase the adoption of FFR in China. In the future, functional evaluation will be fully applying to the strategic guidance of PCI, further improve the effectiveness and quality of PCI treatment in China, and transform China into the world’s successful PCI nation.