Patients with CAD are often advised a minimally invasive procedure called as Percutaneous Coronary Angioplasty in which a stent is introduced to open up the blockage or a Cardiac bypass surgery, a more aggressive procedure in which the smaller arteries are rearranged to reroute the blood to the heart. The choice of procedure is based the results of angiogram – an X-ray of the heart and its blood supply. However, since angiogram is only a visual assessment there may be a possibility of under or overestimating the severity of blockage and prescribing an angioplasty or CABG where it may not be needed.
To overcome this limitation, a new diagnostic modality called the FFR (or Fractional Flow Reserve) can be done after an angiogram to objectively determine the severity of blockage. FFR measurement aids the treating cardiologists in deciding whether or not to perform angioplasty on the blocked vessels.
Recent global studies have proven that angiography alone is inadequate to determine the severity of vessel blockages and angioplasty may not be necessary for all patients with CAD. Therefore, it is important to examine patients with the FFR test prior to determine further treatment as supporting clinical studies have shown that patients who have suffered a heart attack or have unstable angina (also called acute coronary syndrome) are likely to benefit from angioplasty, however, its effect in patients with stable CAD was debatable.
The computer guided FFR test is performed by introducing a thin wire (with a pressure sensor at the tip) into the blocked blood vessel(s) through a catheter (thin hollow tube) and a measurement is noted.
In a normal blood vessel, FFR value equals 1. When the FFR value is greater than 0.80, it indicates a non-significant blockage and that patient may not benefit from angioplasty, and hence could be managed on medication alone. In contrast, if the FFR value is less than 0.80, it indicates a significant blockage and the patient is likely to benefit from intervention, hence angioplasty may be performed
The FFR technology is a safe and established procedure that can be performed at the time of an angiogram. No additional hospitalization is required to perform an FFR test. Most of the leading hospitals in India have the facility for FFR test.
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