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Review
. 2025 Jul:76:1-10.
doi: 10.1016/j.carrev.2025.04.035. Epub 2025 Apr 25.

Pullback pressure gradient: A paradigm shift in physiology-guided revascularization

Anthony Kechichian  1 , Takuya Mizukami  2 , Ganeev Malhotra  3 , James C Spratt  4 , Kazumasa Ikeda  5 , Sara Corradetti  1 , Daniel Munhoz  6 , Koshiro Sakai  7 , Jeroen Sonck  6 , Eric Wyffels  6 , Frédéric Bouisset  8 , Thabo Mahendiran  9 , Bernard De Bruyne  6 , Carlos Collet  10 , Adriaan Wilgenhof  1
Affiliations
Review

Pullback pressure gradient: A paradigm shift in physiology-guided revascularization

Anthony Kechichian et al. Cardiovasc Revasc Med. 2025 Jul.

Abstract

Optimizing decision-making remains essential in the management of stable coronary artery disease (CAD). Recent studies of the pullback pressure gradient (PPG), a novel tool for evaluating CAD patterns, have demonstrated that the effectiveness of percutaneous coronary intervention (PCI) is strongly influenced by the baseline CAD pattern (focal vs diffuse). The capacity of PPG to predict the success of PCI provides a means to better inform decision-making, revascularization strategies and, potentially, improve clinical outcomes.

Keywords: Coronary artery disease; Diffuse CAD; FFR; Focal CAD; PPG.

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Conflict of interest statement

Declaration of competing interest AK, SC and AW are supported by a research grant from the DigiCardioPaTh PhD Program, Sapienza University, Rome, Italy. ThM is supported by a grant from the Swiss National Science Foundation (SNSF). CC reports receiving research grants from Biosensors, Coroventis Research, Medis Medical Imaging, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow, and Abbott; consultancy fees from HeartFlow, OpSens Medical, Abbott, and Philips/Volcano; and has patents assigned and pending on diagnostic methods for coronary artery disease. JS has patents assigned and pending on diagnostic methods for coronary artery disease. BDB has a consulting relationship with Abbott Vascular, CathWorks, Siemens, and Coroventis Research; receives research grants from Abbott Vascular, Coroventis Research, Cathworks; and holds minor equities in Philips-Volcano, Siemens, GE Healthcare, Edwards Life Sciences, HeartFlow, Sanofi, and Celyad. TaM reports receiving research grants from Boston Scientific; and speaker fees from Abbott, CathWorks, and Boston Scientific. FB received consultancy fees from Abbott, Boston Scientific, and B-Braun. JCS has provided consultancy services to Shockwave Medical, Boston Scientific, Abbott Vascular and an institutional research grant from Shockwave Medical. DM reports receiving a research grant provided by the Cardiopath PhD program and speaker fees from Abbott Vascular. GM, KI, EW and KS have no conflicts of interest to disclose.

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