ABSTRACT
This chapter devotes most discussion to those in common use, Fractional flow reserve (FFR), coronary flow reserve (CFR), and potentially the resting instantaneous wave-free pressure ratio. The goal of coronary revascularization with either coronary stenting or bypass surgery is the relief of ischemia and restoration of coronary blood flow. Atherosclerosis predominately involves the large epicardial arteries producing variable resistance to blood flow to the myocardium. The regulation of myocardial blood flow is multifactorial, involving the interaction of the neurohumoral, endothelial, endocrine, paracrine, and metabolic systems with physical factors acting in a largely nonlinear fashion. The modern use of translesional pressure and flow for lesion assessment is for a singular purpose—to overcome the inaccuracy of angiography in identifying those lesions best treated with coronary revascularization. Submaximal hyperemia can be induced with iodinated contrast media as well as intracoronary nitroglycerine.
