The role of non-invasive wireless functional flow reserve physiology assessment of the collaterals-donor vessel in a complex CTO intervention; first case report

We present an interesting case of a 73 years-old male who was referred for mid-right coronary artery (RCA) chronic total occlusion (CTO) intervention given continuous angina symptoms with coronary angiogram revealing mid-RCA CTO with a left to right collaterals from LAD and concomitant moderate stenosis in the mid-LAD. Hemodynamic assessment of this lesion pre-PCI using non-invasive angiogram-based, wireless FFR was performed. Following successful CTO revascularization, a substantial immediate improvement in non-invasive angio-FFR assessment was observed with wireless angio-based FF measurement of 0.96 (normal ≥0.80) compared to the pre-intervention value of 0.86. This suggests that angiography-based wireless FFR may be a valuable tool for assessing the hemodynamic significance of donor artery stenosis in CTO cases, potentially offering a less invasive and more accessible alternative to traditional methods.