The physiopathology of the coronary circulation and angioplasty: Utopia orclinical reality?

Small pressure transducer and Doppler quartz placed at the tip of angioplas ty guide wire give the opportunity to measure coronary flow physiology para meters, the physiopathologic impact of an epicardic coronary stenosis and t he efficacy of its treatment. This gives the opportunity to over ride the c oronary imaging limitations. Doppler and pressure investigate a different and complementary aspect of th e pressure-flow relation and may be used together in some special cases. My ocardial fractional flow reserve (FFRmyo) and relative coronary reserve con cepts allow to evaluate patients with heterogeneous coronary reserve. Clini cal application field is very broad and can be applied to each step of coro nary angioplasty from the evaluation of intermediate lesions and the indica tion of angioplasty to the guidance of the procedure to the evaluation of t he result, through the stenting indication and the stent placement optimiza tion. Numerous studies has emphasized the role of physiologic coronary asse ssment in the cathlab. The time and economic gain of such an attitude has to be confirmed by futur e trials but it is clear now that it is not possible to continue to take de cision on the sol visual aspect of a lesion.