Webinar 10 | Assessment of Left Main Stenosis-Physiologic Assessment of LM, Dr. Bon-Kwon Koo

Video Transcription

Video Summary

Dr. Bong-Kun Koo presented on the physiological assessment of left main coronary artery disease, emphasizing the limitations of angiography alone in determining lesion significance. He highlighted the importance of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in guiding intervention decisions, showing that physiology-guided revascularization is safe and can reduce unnecessary procedures. Dr. Koo addressed challenges such as discordance between FFR and iFR, effects of downstream disease, and complexities in bifurcation lesions. He noted that image-based physiological assessments like angio-FFR are feasible but should be cautiously interpreted, especially for borderline cases. Post-stenting physiology can identify residual ischemia linked to worse outcomes, yet intravascular imaging remains crucial in optimizing complex interventions. In discussions, Dr. Koo and panelists agreed on combining physiology and imaging for better decision-making, especially in complex or borderline lesions. They emphasized individualized treatment considering clinical context, lesion characteristics, and patient factors, advocating for comprehensive use of physiological indices to improve left main PCI outcomes.

Keywords

left main coronary artery disease

fractional flow reserve (FFR)

instantaneous wave-free ratio (iFR)

physiology-guided revascularization

intravascular imaging