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STATE-OF-THE-ART PAPER

Assessment of Intermediate Severity Coronary Lesions in the Catheterization Laboratory

David Geffen School of Medicine at UCLA, Department of Medicine (Division of Cardiology), Los Angeles, California.

Manuscript received June 19, 2006; revised manuscript received September 7, 2006, accepted October 16, 2006.

^_* Reprint requests and correspondence: Dr. Jonathan M. Tobis, David Geffen School of Medicine at UCLA, Adult Cardiac Catheterization Laboratory, BL-394 Center for Health Sciences, Box 171715, 10833 Le Conte Avenue, Los Angeles, California 90095-1717. (Email: jtobis{at}mednet.ucla.edu).

The management of intermediate coronary lesions, defined by a diameter stenosis of 40% to 70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Intravascular ultrasound (IVUS) and fractional flow reserve index (FFR) provide anatomic and functional information that can be used in the catheterization laboratory to designate patients to the most appropriate therapy. The purpose of this review is to discuss the critical information obtained from IVUS and FFR in guiding treatment of patients with intermediate coronary lesions. In addition, the importance of IVUS and FFR in the management of patients with serial stenosis, bifurcation lesions, left main disease, saphenous vein graft disease, and acute coronary syndrome will be discussed.

Abbreviations and Acronyms   ACS = acute coronary syndrome   AMI = acute myocardial infarction   CAD = coronary artery disease   CFR = coronary flow reserve   DES = drug-eluting stent   EEM = external elastic membrane   FFR = fractional flow reserve   IVUS = intravascular ultrasound   MACE = major adverse cardiovascular event   PCI = percutaneous coronary intervention   SPECT = single-photon emission computed tomography   SVG = saphenous vein graft

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