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Fractional Flow Reserve Makes Inroads In Interventional Cardiology

Fractional flow reserve (FFR), a measurement of the severity of a coronary artery obstruction, has not yet reached mainstream use in the US, but that could soon change as interventional cardiologists face increased scrutiny about the “appropriateness” of their clinical treatment decisions. Part of that scrutiny will be driven by recent overstenting scandals, but cost-control measures are playing just much of a role in this shift. At the same time, ongoing advancements in FFR technology are helping to overcome barriers to use and could convince more physicians and hospitals to jump on the FFR bandwagon.

Fractional flow reserve (FFR), a functional measurement of arterial blood flow typically performed during coronary angiography, is slowly beginning to gain traction among US interventional cardiologists seeking additional surety that a patient’s blocked coronary artery needs to be stented. Although FFR is currently used in fewer than 10% of US stenting cases, that number is expected to rise substantially in the coming years as intense cost-control measures come into play and physicians face increasing pressures to reduce unnecessary stenting procedures. And now, what might be described as a second generation of FFR is emerging that has the potential to leap-frog over existing FFR technology. This wave of next-generation technology includes noninvasive computed tomography (CT)-based FFR, developed by start-up HeartFlow Inc., as well as a new adenosine-free FFR technology under development by Volcano Corp. in collaboration with researchers from Imperial College London.

The basic goals of these new approaches are to make FFR measurements more reliable, more versatile, and/or easier to perform, with the ultimate aim of taking FFR from the fringe...

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