Physiology-Guided Management of Serial/Diffuse Coronary Artery Disease

  • Christopher S. G. MurrayEmail author
  • Tariq Siddiqui
  • Norma Keller
  • Solaiman Chowdhury
  • Tamanna Nahar
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease


Purpose of Review

Just over four decades ago, the management of coronary artery disease (CAD) witnessed a major breakthrough with the advent of minimally invasive treatment modalities like angioplasty followed by coronary stenting. Dr. Andreas Gruentzig pioneered this field in 1977 by adding a balloon to the Dotter catheter. From its inception, he was cognizant of the need for measuring pressures before and after balloon inflation in the treated coronary artery, device placement in the treated coronary artery. However, for decades subsequently, emphasis was placed primarily on preprocedural non-invasive tests and angiographic assessment of lesions based on percent diameter stenosis to guide therapeutic interventions. We review the progress of these physiologic advancements in management over the last 20 years, as well as the current state and prospects for the future.

Recent Findings

More recently, clinical features heavily drive the decision whether or not to stent the diseased segment. A little more than two decades ago, a new approach to facilitate the decision whether or not to intervene on intermediate stenoses began to evolve. It became clear that other features besides angiography are important when considering benefit of mechanical intervention. The emphasis shifted to assessment of the physiological significance of coronary lesions, rather than solely anatomical identification of lesions at angiography. Physiological assessments have served to better discriminate potentially flow-limiting lesions, utilizing cutoff measurements to determine which patients would benefit from intervention in addition to medical therapy.


We have found that there is still need for arrival at a consensus as regards the best practice in the context of physiological assessment of serial stenotic lesions, but that studies do show that techniques currently available are non-inferior to each other, and highly effective.


Percutaneous coronary intervention Fractional flow reserve Instantaneous wave-free ratio Flow physiology Revascularization Serial coronary lesions 


Compliance with Ethical Standards

Conflict of Interest

Christopher S. G. Murray, Tariq Siddiqui, Norma Keller, Solaiman Chowdhury, and Tamanna Nahar declare that they have no conflict of interest with regard to this publication.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christopher S. G. Murray
    • 1
    Email author
  • Tariq Siddiqui
    • 2
  • Norma Keller
    • 3
  • Solaiman Chowdhury
    • 1
  • Tamanna Nahar
    • 4
  1. 1.Department of Internal MedicineHarlem Hospital Center/Columbia UniversityNew YorkUSA
  2. 2.Texas Tech University Health Sciences CenterEl PasoUSA
  3. 3.Section of CardiologyBellevue Hospital, NYCNew YorkUSA
  4. 4.Section of Cardiology, Department of Internal MedicineHarlem Hospital Center/Columbia UniversityNew YorkUSA

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