How to prevent unnecessary coronary interventions: identifying lesions responsible for ischemia in the cath lab.

Purpose Of Review: Coronary angiography is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In the catheterization laboratory three techniques can be used for the evaluation of the physiologic significance of intermediate or borderline significant coronary stenoses: (1) pressure wire-derived coronary fractional flow reserve (FFR), (2) Doppler wire-derived measurement of coronary flow reserve (CFR), and (3) intravascular ultrasound (IVUS).

Recent Findings: All of these techniques have been validated for assessing the functional significance of intermediate stenoses, but also have inherent limitations.

Summary: Overall, measurement of FFR appears to be the best method for interrogating intermediate coronary lesions. This review discusses the strengths and limitations of each of these techniques.