A novel technique in the use of fractional flow reserve in coronary artery bifurcation lesions.

The side branch (SB) in bifurcation lesions is a frequently encountered challenge that interventional cardiologists must face. There is great interest in determining fractional flow reserve (FFR) in the SB to help guide treatment decisions; however, difficulty with the pressure guidewire limits its widespread use. We propose a novel technique that will ease the incorporation of FFR in routine evaluation of bifurcation lesions, and allow better assessment of provisional stenting and need for SB intervention. Conventionally, to measure SB FFR, the jailed SB is re-crossed through the stent strut using a pressure wire. Our technique involves the use of a microcatheter and wire exchange within the SB, thereby alleviating some of the technical difficulties associated with the FFR wire. In light of the difficulties and clinical concerns associated with bifurcation lesions, we propose an innovative method to ease the incorporation of FFR to allow better assessment of provisional stenting and need for SB intervention.