Coronary Pressure

Coronary pressure measurement has emerged as a major step forward in the invasive assessment of coronary artery disease. This was made possible on one hand by technical progress in developing pressure-monitoring guide wires, and on the other hand to a theoretical innovation, the concept of coronary pressure-derived fractional flow reserve which closely relates distal coronary pressure to myocardial flow. In the catheterization laboratory, fractional flow reserve enables an "on-the-spot" quantification of the extent to which a given epicardial stenosis contributes to reversible myocardial ischemia and the decision whether revascularization of the stenosis is warranted or not. Moreover, this new approach has proven to be valuable in many complex diagnostic situations encountered in the catheterization laboratory. In addition, pressure-derived fractional flow reserve appears to be a useful index in monitoring and guiding coronary intervention, including stent deployment.In this text, the theoretical and physiological background of this approach is systematically reviewed and the most advanced clinical applications are illustrated, both at diagnostic and interventional catheterization. Practical set-up of coronary pressure measurement, including tips, tricks, and potential pitfalls are particularly emphasized in this new edition.