Pullback pressure gradient: A paradigm shift in physiology-guided revascularization

Figures

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  Figure 1. Autoregulation in coronary physiology is regulated by multiple factors control the vascular tone of pre-arterioles and arterioles, which maintain resting flow constant until the point of maximal vasodilatation, when flow is driven exclusively by the perfusion pressure. At that point, pressure and flow can be assumed to be equivalent.

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  Figure 2. Showing the #FullPhysiology algorithm: 1. The first step is devoted to epicardial assessment: hyperemic metrics (FFR and/or cFFR) are strongly recommended over the NHPRs. 2. The second step involves the microvascular assessment via bolus thermodilution. 3. Acetylcholine provocation test is then done as the third part of the protocol. 4. Finally, if PCI is performed, the epicardial assessment should be repeated to check for the functional result.

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  Figure 3. Showing the multiple mechanism leading to myocardial ischemia.