Use of fractional flow reserve in different anatomical subsets

Fractional flow reserve (FFR) has become the gold standard for assessing the haemodynamic significance of coronary artery lesions in the cardiac catheterization laboratory. The accurate measurement of FFR is dependent on flow proximal and distal to the lesion, and hence is affected by commonly encountered anatomical subsets such as serial lesions, bifurcation, and left main lesions. Through a comprehensive review of the available literature, we aim to outline the specific issues that need to be considered when utilizing FFR in these specific coronary artery disease anatomical subsets. It is important to understand the limitations of FFR and the specific effect that anatomical variations have on the measured FFR value. Interpreting the physiological data appropriately when dealing with these anatomical subsets will allow the operator to effectively use FFR in the cardiac catheterization laboratory.