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CLINICAL RESEARCH

Physiologic Assessment of Jailed Side Branch Lesions Using Fractional Flow Reserve

Bon-Kwon Koo, MD, PhD^_*, Hyun-Jai Kang, MD, PhD^_*, Tae-Jin Youn, MD, PhD, In-Ho Chae, MD, PhD, Dong-Joo Choi, MD, PhD, Hyo-Soo Kim, MD, PhD^_*, Dae-Won Sohn, MD, PhD^_*, Byung-Hee Oh, MD, PhD, FACC^_*,_*, Myoung-Mook Lee, MD, PhD, FACC^_*, Young-Bae Park, MD, PhD^_*, Yun-Shik Choi, MD, PhD^_* and Seung-Jae Tahk, MD, PhD

^_* Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center and Cardiovascular Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
Cardiovascular Center, Bundang Seoul National University Hospital, Seongnam, Gyeonggi-do, Republic of Korea
Ajou University School of Medicine, Suwon, Republic of Korea

Manuscript received February 14, 2005; revised manuscript received April 20, 2005, accepted April 25, 2005.

^_* Reprint requests and correspondence: Dr. Byung-Hee Oh, Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Yongon-dong 28, Jongno-gu, Seoul, Republic of Korea, 110-744 (Email: ohbhmed{at}snu.ac.kr).

OBJECTIVES: This study was performed to evaluate the feasibility of the physiologic assessment of jailed side branches using fractional flow reserve (FFR) and to compare the measured FFR with the stenosis severity assessed by quantitative coronary angiography (QCA).

BACKGROUND: It is not well-known which side branches should be treated after stent implantation at main branches and how to assess the functional significance of these lesions.

METHODS: Ninety-seven jailed side branch lesions (vessel size >2.0 mm, percent stenosis >50% by visual estimation) after stent implantation at main branches were consecutively enrolled. The FFR was measured using a pressure wire at 5 mm distal and proximal to the ostial lesion of the jailed side branch.

RESULTS: The FFR measurement was successful in 94 lesions. Mean FFRs were 0.94 ± 0.04 and 0.85 ± 0.11 at the main branches and jailed side branches, respectively. There was a negative correlation between the percent stenosis and FFR (r = –0.41, p < 0.001). However, no lesion with <75% stenosis had FFR <0.75. Among 73 lesions with 75% stenosis, only 20 lesions were functionally significant.

CONCLUSIONS: The FFR measurement in jailed side branch lesions is both safe and feasible. Quantitative coronary angiography is unreliable in the assessment of the functional severity of jailed side branch lesions, and measurement of FFR suggests that most of these lesions do not have functional significance.

Abbreviations and Acronyms   FFR = fractional flow reserve   QCA = quantitative coronary angiography   TIMI = Thrombolysis In Myocardial Infarction

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