Co-registration of fractional flow reserve and optical coherence tomography with the use of a three-dimensional angiographic roadmap: an opportunity for optimisation of complex percutaneous coronary interventions

Angiography of a 63-year-old male patient with unstable angina revealed a tight stenosis in the mid right coronary artery, proximal to a formerly implanted drug-eluting stent (DES). A motorised pullback of the pressure wire at 1 mm/sec during IV adenosine (140 μg/kg/min) permitted co-registration of the pressure-derived fractional flow reserve (FFR) signal along the angiographic roadmap, and the precise length (12 mm) of the segment where the pressure “jump” was derived. Additional OCT co-registration was performed revealing extensive spiral dissection at the proximal edge of the stent, extending for 23 mm proximally, and not detectable by angiography on any view (Figure 1, ...