{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T02:28:42Z","timestamp":1782872922804,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T00:00:00Z","timestamp":1592352000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The study aimed to demonstrate through instant wave\u2010free ratio (iFR) measurements that myocardium distal to a chronic total occlusion (CTO) is ischemic, that ischemia is reversible by PCI, and that iFR assessment after PCI can be used to optimize PCI results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>The greatest benefit of revascularization is found in patients with low fractional flow reserve. In patients with CTOs, iFR measurement may be more appropriate to evaluate ischemia as it does not require maximal microvascular vasodilation, which may be hampered by microvascular dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The iFR was measured in 81 CTO patients, both pre\u2010 and post\u2010PCI in 63 patients, and only post\u2010PCI in the following 18 patients. A pressure wire pullback was performed post\u2010PCI if iFR \u22640.89.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The first 63 patients all had significant ischemia distal to the CTO with a median iFR of 0.33 [0.22; 0.44], improving significantly post\u2010PCI to a median iFR of 0.93 [0.89;0.96] (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). In the complete cohort, the median iFR post\u2010PCI was 0.93 [0.86;0.96] but still \u22640.89 in 23 patients (30%). 12 of these patients had further PCI optimization because of a residual focal pressure gradient on pullback, after which only two had a final iFR \u22640.89.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In CTO patients with an indication for PCI, iFR consistently demonstrated profound myocardial ischemia. Successful PCI immediately relieved ischemia in 70% of patients. In the remaining 30% of cases, a manual iFR pullback proved helpful in guiding further optimization of the PCI result.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29072","type":"journal-article","created":{"date-parts":[[2020,6,17]],"date-time":"2020-06-17T07:45:11Z","timestamp":1592379911000},"page":"646-655","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["iFR uncovers profound but mostly reversible ischemia in CTOs and helps to optimize PCI results"],"prefix":"10.1002","volume":"97","author":[{"given":"Peter","family":"Kayaert","sequence":"first","affiliation":[{"name":"Department of Cardiology Ghent University Hospital  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Coeman","sequence":"additional","affiliation":[{"name":"Department of Cardiology Ghent University Hospital  Ghent 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