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Review
. 2022 Nov 14;15(21):2174-2191.
doi: 10.1016/j.jcin.2022.07.015.

Functional Patterns of Coronary Disease: Diffuse, Focal, and Serial Lesions

Roberto Scarsini  1 , Simone Fezzi  2 , Antonio Maria Leone  3 , Giovanni Luigi De Maria  4 , Michele Pighi  5 , Michele Marcoli  5 , Domenico Tavella  5 , Gabriele Pesarini  5 , Adrian P Banning  4 , Emanuele Barbato  6 , William Wijns  7 , Flavio L Ribichini  5
Affiliations
Free article
Review

Functional Patterns of Coronary Disease: Diffuse, Focal, and Serial Lesions

Roberto Scarsini et al. JACC Cardiovasc Interv. .
Free article

Abstract

The physiological assessment of coronary lesions is influenced by the pattern and distribution of coronary artery disease (CAD), including focal lesions, serial lesions, diffuse disease, and mixed patterns. These various patterns of CAD impact the accuracy of pressure wire and angiography-derived physiology indexes, and diffuse disease in particular is an important determinant of the anticipated outcome of percutaneous coronary intervention. Therefore, identification of the physiological pattern of disease provides relevant information for the management of CAD and percutaneous coronary intervention procedural planning. At present, the classification of physiological patterns and its implications for the tailored management of a patient with CAD are poorly defined. This state-of-the-art review provides an overview of the available evidence on functional patterns of CAD with a special focus on their diagnostic and therapeutic implications. It also aims to provide clear definitions of physiological patterns of CAD based on the available evidence and expert opinion. A practical algorithm is provided to optimize the use of pressure wire and angiography-derived indexes of coronary physiology in the settings of focal, serial, and diffuse lesions, with the addition of intracoronary imaging in selected cases.

Keywords: fractional flow reserve; functional angiography; instantaneous wave-free ratio; intracoronary imaging; percutaneous coronary intervention; quantitative flow ratio.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Scarsini has received speaker fees from Abbott Vascular; and has received a research grant from Philips and Abbott. Dr Leone is an advisor for Abbott Vascular and Bracco Imaging; and has received speaking honoraria from Abbott Vascular, Bracco Imaging, Medtronic, Abiomed, and Bristol Myers Squibb. Dr De Maria has received speaker fees from Miracor and Abbott; and has received a research grant from Abbott, Miracor, Medtronic, Terumo, Philips, and Medis. Dr Banning has received speaker fees from Abbott Vascular; and has received research grant from Boston Scientific. Dr Barbato has received speaker fees from Boston Scientific, Abbott Vascular, General Electric Healthcare and Opsens. Dr Wijns has received research grants and honoraria from MicroPort; is a medical advisor of Rede Optimus Research and Corrib Core Laboratory; and is a cofounder of Argonauts, an innovation facilitator. Dr Ribichini has received research grants from Philips and Abbott. Drs Fezzi and Wijns were supported by a Research Professorship Award from Science Foundation Ireland (15/RP/2765). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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