Experimental Bench for Hemodynamic Study of Coronary Artery with Serial Stenoses: Fractional Flow Reserve Assessment

Q: What is the clinical evidence from this study?

Population: Coronary artery disease with serial stenoses. Intervention: Pressure-derived Fractional Flow Reserve (FFR) assessment across serial stenoses (S1=30%, S2=30% or 60%) vs. Single stenosis conditions (S1=30% or 60%, S2=0%). Primary outcome: Global Fractional Flow Reserve (FFRg = Pd/Pa) and Intermediate Fractional Flow Reserve (FFRi = Pm/Pa).

Q: What does this research mean for the field?

In a coronary phantom model, adding a 60% distal stenosis to a 30% proximal stenosis reduces global FFR from 0.88 to 0.55 while intermediate FFR remains at 0.90. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ricardo Coppel; AL. Gomez; Gérard Finet; RI. Pettigrew; Jacques Ohayon; Manuel Lagache

doi:10.1080/10255842.2017.1382853

October 27, 2017Computer Methods in Biomechanics & Biomedical EngineeringOpen Access

Experimental Bench for Hemodynamic Study of Coronary Artery with Serial Stenoses: Fractional Flow Reserve Assessment

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Key result

Adding a distal 60% stenosis cuts global FFR by ~0.33 points in a serial lesion model.

Why the study?

Does the presence and severity of a second serial stenosis affect global and intermediate Fractional Flow Reserve (FFR) measurements in an experimental coronary artery phantom?

Key Points

To develop an experimental hemodynamic bench to investigate how serial coronary artery stenoses of varying severities influence global and intermediate fractional flow reserve measurements.
Constructed a silicone coronary vessel phantom (4 mm internal diameter, 0.5 mm wall thickness) connected to a circulatory bench with a pulsatile pump set at 65 beats per minute and a flow rate of 300 ml/min to mimic hyperemic coronary conditions.
Tested stenosis models with 30% and 60% diameter reduction spaced 20 mm apart, recording mean pressures before lesions (Pa), between lesions (Pm), and distally (Pd) using a 1 mm liquid-filled catheter.
In single-stenosis tests, global fractional flow reserve (FFRg) was 0.88 ± 0.02 for a 30% stenosis and 0.71 ± 0.02 for a 60% stenosis (n>5).
In serial stenoses, introducing a second stenosis decreased FFRg to 0.77 ± 0.02 for 30%-30% lesions and 0.55 ± 0.01 for 30%-60% lesions, while intermediate fractional flow reserve (FFRi) increased from 0.87 ± 0.01 to 0.90 ± 0.01.

Structured PICO

Does the presence and severity of a second serial stenosis affect global and intermediate Fractional Flow Reserve (FFR) measurements in an experimental coronary artery phantom?

P

Population

In vitro silicone coronary artery phantom (4 mm internal diameter) tested across 4 experimental protocols (n>5 per protocol) with single or serial stenoses (30% and 60% diameter reduction).

I

Intervention

Pressure-derived global FFR (FFRg = Pd/Pa) and intermediate FFR (FFRi = Pm/Pa) measurement using a 1 mm liquid-filled catheter across serial stenoses (S1=30% with S2=30%, and S1=30% with S2=60%).

C

Comparator

Single stenosis phantom protocols (S1=30%, S2=0% and S1=60%, S2=0%) and previously published clinical reference values (Takagi et al. 1999).

O

Outcome

Global Fractional Flow Reserve (FFRg = Pd/Pa) and Intermediate Fractional Flow Reserve (FFRi = Pm/Pa) amplitudes.surrogate

Main Result

Absolute Event Rate: 0.55% vs 0.88%

This in vitro hemodynamic bench study demonstrates that adding a second distal coronary stenosis significantly lowers global FFR while slightly increasing intermediate FFR across the proximal lesion, validating an experimental setup for studying complex serial stenoses.

Limitations

Silicone phantom elastic behavior differs from a native human artery wall
Water was used as the working fluid rather than a fluid matching the density and viscosity of blood
Use of a relatively large 1 mm diameter catheter affected FFR measurements and prevented evaluation of lesions up to 80% diameter reduction
Phantom elastic behavior is not fully similar to an actual artery wall
Water was used as the working fluid instead of a fluid with the same density and viscosity as blood
1 mm diameter catheter size influences FFR measurements compared to a smaller 0.35 mm wire/catheter

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Implication

Serial stenoses warrant cautious FFR interpretation; extends phantom models but leaves open clinical validation.

Abstract

The measurement of Fractional Flow Reserve (FFR) becomes essential for an interventional cardiologist to decide whether or not an angioplasty or stenting procedure needs to be performed on his pati...

Discussion

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Cite This Study

Coppel et al. (2017) studied Coronary artery disease with serial stenoses. Pressure-derived Fractional Flow Reserve (FFR) assessment across serial stenoses (S1=30%, S2=30% or 60%) vs. Single stenosis conditions (S1=30% or 60%, S2=0%) was evaluated on Global Fractional Flow Reserve (FFRg = Pd/Pa) and Intermediate Fractional Flow Reserve (FFRi = Pm/Pa).

synapsesocial.com/papers/6a93bd79736f279a1f7c1516 https://doi.org/10.1080/10255842.2017.1382853

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Experimental Bench for Hemodynamic Study of Coronary Artery with Serial Stenoses: Fractional Flow Reserve Assessment

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Experimental Bench for Hemodynamic Study of Coronary Artery with Serial Stenoses: Fractional Flow Reserve Assessment

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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