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By : Masoud.Sajjadi
Consultant Interventional Cardiologist at Razavi Hospital
Mashhad , Iran
Aug 2023
Intracoronary imaging-Guided PCI
( Practical Measurements )
Hemodynamically Significant Vessel Disease
A. FFR <0.8 ( Ref : FAME Trial . NEJM 2009 )
B. IC Imaging
IVUS Left Main ( Ref : AHA Guideline 2017 )
MLA < 6mm2 or MLD < 2.8 mm considered physiologically significant
MLA >7.5 mm2 revascularization may be safely deffered
MLA 6-7.5 mm2 FFR is recommended
Non-Left Main : ( 2/3 Proximal Epicardial vessels ) : MLA < 4mm2 generally considered significant
OCT Non-Left Main ( Ref : Forza trial . JACC 2020 )
AS > 75% or
AS 50-75% with Plaque Rupture or
AS 50-75% with MLA < 2.5 mm2 ( best value to predict FFR )
MLD ( Minimal Lumen Diameter ) . MLA ( Minimal Lumen Area ) . AS ( Area of stenosis )
Stent Underexpansion & Target MSA
Left Main ( IVUS-derived MSA Cut-off values to predict ISR & MACE )
( Ref : Circulation CV Intervention 2011 )
MSA > 5mm2 for Ostial LCX
MSA > 6mm2 for Ostial LAD
MSA > 7mm2 for POC
MSA > 8mm2 for LM Proximal to POC
Non-Left Main MSA < 5.5 mm2 by IVUS or MSA < 4.5 mm2 by OCT ( Underexpanded stent )
( Ref : Eurointervention 2018 )
MSA ( Minimal stent area )

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IC-Guided Practical Measurements.pdf

  • 1. By : Masoud.Sajjadi Consultant Interventional Cardiologist at Razavi Hospital Mashhad , Iran Aug 2023 Intracoronary imaging-Guided PCI ( Practical Measurements )
  • 2. Hemodynamically Significant Vessel Disease A. FFR <0.8 ( Ref : FAME Trial . NEJM 2009 ) B. IC Imaging IVUS Left Main ( Ref : AHA Guideline 2017 ) MLA < 6mm2 or MLD < 2.8 mm considered physiologically significant MLA >7.5 mm2 revascularization may be safely deffered MLA 6-7.5 mm2 FFR is recommended Non-Left Main : ( 2/3 Proximal Epicardial vessels ) : MLA < 4mm2 generally considered significant OCT Non-Left Main ( Ref : Forza trial . JACC 2020 ) AS > 75% or AS 50-75% with Plaque Rupture or AS 50-75% with MLA < 2.5 mm2 ( best value to predict FFR ) MLD ( Minimal Lumen Diameter ) . MLA ( Minimal Lumen Area ) . AS ( Area of stenosis )
  • 3. Stent Underexpansion & Target MSA Left Main ( IVUS-derived MSA Cut-off values to predict ISR & MACE ) ( Ref : Circulation CV Intervention 2011 ) MSA > 5mm2 for Ostial LCX MSA > 6mm2 for Ostial LAD MSA > 7mm2 for POC MSA > 8mm2 for LM Proximal to POC Non-Left Main MSA < 5.5 mm2 by IVUS or MSA < 4.5 mm2 by OCT ( Underexpanded stent ) ( Ref : Eurointervention 2018 ) MSA ( Minimal stent area )