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Int J Angiol 2021; 30(01): 040-047
DOI: 10.1055/s-0041-1723942
Review Article

Functional Assessment of Coronary Artery Lesions—Old and New Kids on the Block

Prashant Patel
1   Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
2   UC Riverside School of Medicine, University of California, Riverside, California
,
Ravi Rao
1   Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
2   UC Riverside School of Medicine, University of California, Riverside, California
,
Prabhdeep Sethi
1   Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
2   UC Riverside School of Medicine, University of California, Riverside, California
,
Ashis Mukherjee
1   Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
2   UC Riverside School of Medicine, University of California, Riverside, California
,
Padmini Varadarajan
1   Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
2   UC Riverside School of Medicine, University of California, Riverside, California
,
Ramdas G. Pai 
1   Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
2   UC Riverside School of Medicine, University of California, Riverside, California
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Abstract

Angiography is inaccurate in assessing functional significance of coronary lesions, and often stenoses deemed severe on angiographic assessment do not restrict coronary blood flow at rest or with maximal dilatation. Angiography-guided revascularization has not shown improvement in hard clinical outcomes in stable ischemic heart disease (SIHD). Most current guidelines for SIHD recommend invasive functional assessment of lesions to guide revascularization if prior evidence of ischemia is not available. There has been several recent advances and development of novel methods in this arena. Various contemporary clinical trials have been undertaken for validation of these indices. Here we review the physiological basis, tools, techniques, and evidence base for various invasive (resting as well as hyperemic) and noninvasive methods for functional assessment of coronary lesions. Left main stenosis, bifurcation lesions, serial stenosis, and acute coronary syndrome each causes unique disequilibrium that may affect measurements and require special considerations for accurate functional assessment.

Keywords

coronary stenosis - functional significance - angioplasty - coronary artery disease - perfusion


Publication History

Article published online:
12 February 2021

© 2021. International College of Angiology. This article is published by Thieme.

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