Al Nooryani Arif, Aboushokka Wael, Beleslin Branko, Nedeljkovic-Beleslin Biljana
Department of Cardiology, Al Qassimi Hospital, Sharjah 1234, United Arab Emirates.
Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade 11000, Serbia.
World J Clin Cases. 2024 May 6;12(13):2269-2274. doi: 10.12998/wjcc.v12.i13.2269.
Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.
We present a case of 55-year-old male diabetic patient who was admitted for chest pain. Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent. Patient undergone invasive functional testing of intermediate lesion with preserved FFR (0.88), low coronary flow reserve (1.2) and very high index of microvascular resistance (84). Due to discrepancy in invasive functional parameters, intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma. Because of the preserved FFR and no signs of vulnerable plaque, the interventional procedure was deferred and the patient continued with optimal medications.
Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.
通过血流储备分数（FFR）进行的有创功能评估被认为是评估中度冠状动脉狭窄的金标准。然而，在因动脉粥样硬化加速进展而患糖尿病的患者中，即使功能测试结果为阴性，预后可能也更差。
我们报告一例55岁男性糖尿病患者，因胸痛入院。诊断性冠状动脉造影显示钝缘支有2处中度狭窄，先前植入的支架无再狭窄迹象。患者接受了对中度病变的有创功能测试，结果显示FFR保留（0.88）、冠状动脉血流储备低（1.2）和微血管阻力指数非常高（84）。由于有创功能参数存在差异，光学相干断层扫描血管内成像显示为纤维化狭窄，无薄帽纤维粥样斑块迹象。由于FFR保留且无易损斑块迹象，介入手术被推迟，患者继续接受最佳药物治疗。
糖尿病患者中度冠状动脉狭窄的功能与解剖联合成像代表了患者管理中全面的当代决策路径。
