MEDTRONIC: Physiology-guided side branch intervention with CathWorks FFRangio – Luca Testa

Discussion on New Technology in Cardiology

Introduction to the Technology

• The speaker expresses gratitude for the opportunity to discuss a new technology, revealing it took nearly a year to be convinced of its regular use in clinical practice.

• The presentation was modified last minute, omitting slides related to bifurcation physiology and focusing instead on a specific case study.

Case Presentation

• A male patient in his 60s with a medical history of former smoking, obesity, hypertension, and prostate hypertrophy presented with prolonged chest pain and was labeled as non-ST elevation myocardial infarction (non-STEMI).

• An echocardiogram indicated mildly reduced ejection fraction and hypokinesia of the anterior lateral wall; coronary angiography revealed diffuse disease but no significant findings initially.

Analysis Using Cat Works Technology

• The speaker introduces Cat Works, an angiography-based fractional flow reserve (FFR) tool that has shown effectiveness comparable to invasive FFR methods.

• Emphasizes the importance of color-coded colony segmentation for understanding physiological significance across different segments during analysis.

Physiological Evaluation Results

• The analysis highlighted significant areas in the left anterior descending artery (LAD), indicating positive results for ischemia based on color coding.

• Cat Works provided detailed information about myocardial volume affected by FFR values below 0.8, consistent with anatomical findings from angiography.

Interventional Strategy and Outcomes

• The interventional strategy involved using various balloon sizes and types based on measurements from Cat Works; initial results were satisfactory.

• Post-intervention evaluation showed improved FFR readings with no myocardial volume showing ischemia post-procedure, suggesting successful treatment outcomes.

Conclusions Drawn from the Case

• The speaker stresses that physiological assessment is crucial for determining whether further intervention is necessary after achieving acceptable angiographic results.

• Patient management included minimizing dual antiplatelet therapy duration even in cases of acute coronary syndrome (ACS), highlighting a tailored approach to care.

Future Considerations

• Plans include conducting follow-up CT scans rather than routine angiograms due to their less invasive nature; this aligns with efforts to reduce patient invasiveness starting from initial assessments.

• Concludes that while side branch interventions remain challenging in PCI bifurcations, tools like Cat Works can significantly aid in evaluating treatment necessity effectively.