Introduction: Stenosis assessment using angiographic images is standard in everyday clinical practice. However, when combined with intravascular evaluation, patient outcomes dramatically improve, which has been confirmed by numerous large multicentre studies and is incorporated in current guidelines on revascularisation. Intravascular ultrasonography (IVUS) is a procedure using specifically designed probes on guidewire tips that can characterize plaque morphology, lesion length, as well as stenosis significance by calculating minimal lumen area of vessels (MLA) and gives valuable data on stent apposition, instent restenosis and carina shift during bifurcation stenting. Fractional flow reserve (FFR) and instantaneous wave free ratio (IFR) uses pressure tip guidewires to measure pressure drops on lesions and has certain “cut-off” values for stent deferral. (1, 2)

Results: We present our data using IVUS and FFR/IFR guided PCI in University Hospital Dubrava from the period of January 2016-January 2018. In total 31 patient underwent IVUS assessment, majority of which the indication was evaluation of coronary artery stenosis (61%). Of them, 68% were studies done on LM/ostial LAD stenosis. Four patients were referred to surgical revascularization, 16 patients underwent PCI and 11 patients were deferred. The mean MLA was 3.29 that guided adequate stent sizing and later apposition confirmation. In follow-up there were no registered deaths, there was only one TLF needing PCI, with no other MACE or angina worsening detected. In the same period 20 patients underwent FFR/IFR evaluation. All patients had stable coronary artery disease and a value of 0.80 for FFR and 0.90 for IFR respectively were used for stent deferral. On average 1.9 vessels were evaluated per patient, the LAD being the leading vessel (48%). In the series 55% of patients underwent PCI with a mean IFR value of 0.82, and the mean deferral value was 0.93. On follow up no MACE or angina worsening were detected.

Conclusion: IVUS and FFR/IFR pose a valuable addition in stenosis assessment and characterization, providing information to help guide the operator in optimal decision making and favor better patient outcomes. The procedures are safe and time-efficient, although still costly making its utilization underscored.