Novel assessment of haemodynamics in the peripheral … · 2017. 12. 11. · Bijan Modarai PhD FRCS...
Transcript of Novel assessment of haemodynamics in the peripheral … · 2017. 12. 11. · Bijan Modarai PhD FRCS...
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Bijan Modarai PhD FRCSReader/Consultant Vascular Surgeon
British Heart Foundation Senior Fellow
Academic Department of Vascular Surgery
Guy’s & St Thomas’ NHS Foundation Trust, King’s College London
Novel assessment of haemodynamics in the
peripheral vasculature using Combowire
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Disclosures
None relevant to this talk
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Optimal assessment of peripheral vasculature
➢ Functional assessment
➢ Effect of exercise
➢ Multi-level disease
➢ Collaterals
➢ Microcirculation
➢ Tissue perfusion
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Invasive haemodynamic assessment
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Fractional Flow Reserve (FFR)
➢Index of the physiologic significance of stenosis
➢Maximal blood flow in stenotic artery: normal maximal flow
➢Hyperaemia induces a pressure drop
➢FFR <0.8 = 90% predictive of coronary ischaemia
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Hyperaemia: Achieving maximal blood flow
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Pjils et al. JACC 2010
➢FFR threshold (<0.8)
➢FFR vs angio guided treatment
➢No. stents used 2.7 vs 1.9 (p<0.001)
➢MI/death 13% vs 9% (P<0.02)
FFR Guided selection of coronary lesions that merit treating
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Stenosis >70%FFR 0.93
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Cardiovasc Revasc Med 2017
FFR 0.5 predicts >70% visual stenosisBefore Intervention After Intervention
Diameter stenosis (%) 65 +/-23 26 +/-13
FFR 0.60 +/-0.19 0.77+/-0.12
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Kobayash et al. J Endovasc Ther 2016
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➢ Collaterals > half of flow in normal arteries
➢ Prevents symptoms for 5mins of exercise
➢ Low collateral flow index: Poor exercise tolerance
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Haemodynamic contribution of collaterals
Extensive collateralsPoor collaterals
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Computational fluid dynamics
Xu et al. Nature Scientific Reports 2016
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Computational Fluid Dynamics: SFA Stenosis
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Non-invasive assessment of haemodynamics / tissue perfusion
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➢ Wires allow refined haemodynamic assessment in the lower limb
➢ Invasive Pressure/Velocity measurement
➢ Targeted treatment
➢ Functional role of collaterals
➢ Non-invasive: Computational Fluid Dynamics
Summary
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ACKNOWLEDGEMENTS
Mostafa Albayati
Adnan Bajwa
Alberto Smith
Ashish Patel
Hany Zayed
Sanjay Patel
Devaka Perera
RyoTorii
Eike Nagel
Francesca Ludwinski
Prakash Saha
Oliver Lyons
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Mostafa Albayati
Adnan Bajwa
Alberto Smith
Ashish Patel
Hany Zayed
Sanjay Patel
Devaka Perera
RyoTorii
Eike Nagel
Francesca Ludwinski
Prakash Saha
Oliver Lyons