BACKGROUND Invasive functional evaluation by fractional flow reserve(FFR)is considered as a gold standard for the evaluation of intermediate coronary stenosis.However,in patients with diabetes due to accelerated progr...BACKGROUND Invasive functional evaluation by fractional flow reserve(FFR)is considered as a gold standard for the evaluation of intermediate coronary stenosis.However,in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.CASE SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest pain.Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent.Patient undergone invasive functional testing of intermediate lesion with preserved FFR(0.88),low coronary flow reserve(1.2)and very high index of microvascular resistance(84).Due to discrepancy in invasive functional parameters,intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma.Because of the preserved FFR and no signs of vulnerable plaque,the interventional procedure was deferred and the patient continued with optimal medications.CONCLUSION Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.展开更多
Coronary lesions of intermediate severity, defined as 50%-70% luminal diameter narrowing by visualestimation at angiography, are frequently encountered in patients with stable or unstable coronary artery disease. Clin...Coronary lesions of intermediate severity, defined as 50%-70% luminal diameter narrowing by visualestimation at angiography, are frequently encountered in patients with stable or unstable coronary artery disease. Clinical decision making for patients with intermediate coronary stenosis is still challenging, but may be facilitated by assessing the morphology and physiological significance of these lesions.1 It is clear that angiographic stenosis is a highly unreliable surrogate for myocardial ischemia, as a significant proportion of anatomically high-grade lesions do not cause ischemia. Conversely, even for anatomically mild coronary lesions, a non-negligible rate of myocardial ischemia is consistently noted. Because the physiological significance of a lesion is mainly determined by both the severity of a stenosis and the amount of myocardium supplied, coronary angiography alone does not accurately predict the functional significance of intermediate coronary lesions.2,3展开更多
文摘BACKGROUND Invasive functional evaluation by fractional flow reserve(FFR)is considered as a gold standard for the evaluation of intermediate coronary stenosis.However,in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.CASE SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest pain.Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent.Patient undergone invasive functional testing of intermediate lesion with preserved FFR(0.88),low coronary flow reserve(1.2)and very high index of microvascular resistance(84).Due to discrepancy in invasive functional parameters,intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma.Because of the preserved FFR and no signs of vulnerable plaque,the interventional procedure was deferred and the patient continued with optimal medications.CONCLUSION Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.
文摘Coronary lesions of intermediate severity, defined as 50%-70% luminal diameter narrowing by visualestimation at angiography, are frequently encountered in patients with stable or unstable coronary artery disease. Clinical decision making for patients with intermediate coronary stenosis is still challenging, but may be facilitated by assessing the morphology and physiological significance of these lesions.1 It is clear that angiographic stenosis is a highly unreliable surrogate for myocardial ischemia, as a significant proportion of anatomically high-grade lesions do not cause ischemia. Conversely, even for anatomically mild coronary lesions, a non-negligible rate of myocardial ischemia is consistently noted. Because the physiological significance of a lesion is mainly determined by both the severity of a stenosis and the amount of myocardium supplied, coronary angiography alone does not accurately predict the functional significance of intermediate coronary lesions.2,3
