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Fractional Flow Reserve FFR

Fractional Flow Reserve (FFR) is an advanced diagnostic technique that measures blood flow and pressure within the coronary arteries to determine whether a blockage is restricting blood supply to the heart and requires treatment.

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Fractional Flow Reserve FFR

Fractional Flow Reserve (FFR) is a specialized technique used during coronary catheterization to measure pressure differences across a coronary artery stenosis. This helps determine whether the narrowing is significantly reducing oxygen-rich blood flow to the heart muscle.
FFR provides accurate information about the severity of coronary artery blockages and helps cardiologists decide whether procedures such as angioplasty or stent placement are necessary. The procedure is minimally invasive and is performed using a pressure-sensitive guidewire during coronary angiography.
This technique plays an important role in identifying functionally significant blockages and improving treatment outcomes while avoiding unnecessary interventions.

Indications

  • ✓ Multivessel disease
  • ✓ Acute coronary syndrome
  • ✓ Left main lesions
  • ✓ Bifurcation lesions
  • ✓ Bypass graft assessment

During Coronary Catheterization

  • A catheter is inserted through the femoral or radial artery.

  • A sheath and guidewire are advanced to the coronary artery.

  • FFR uses a small pressure sensor located at the tip of the guidewire.

  • The sensor measures pressure, temperature, and blood flow.

  • These measurements determine the exact severity of the lesion.

  • The assessment is performed during maximal blood flow (hyperemia).

  • Hyperemia is induced using medications such as adenosine or papaverine.

  • The guidewire is gradually pulled back.

  • Pressure measurements are recorded across the vessel.

Fractional Flow Reserve Procedure
Fractional Flow Reserve Equation

Equation

  • FFR is the ratio of maximum blood flow distal to a stenotic lesion to the normal maximum blood flow in the same vessel.

  • It is calculated using the pressure ratio.

  • Pd = Pressure distal to the lesion.

  • Pa = Pressure proximal to the lesion.

Equipment

  • Guiding catheter.

  • Pressure-monitoring guidewire.

  • Hyperemic stimulus.

  • Vasodilation administration to achieve maximal hyperemia of the coronary artery.

Fractional Flow Reserve Equipment
Fractional Flow Reserve Complications

Complications (Rare)

  • Transient bradycardia (1.7%).

  • Coronary spasm (2%).

  • Ventricular fibrillation (0.2%).

  • Vessel trauma.