case_images: PMC6737447_01
case_images: A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Coronary computed tomography (CT) angiography curved multiprojection reconstructions of the right (right coronary artery), the left anterior descending, the left circumflex, and the left main coronary arteries as well as the ramus. Red arrow: Coronary stenosis; blue arrow: CT-derived fractional flow reserve reading [cf. Figure 2].
case_images: JCIS-9-39-g001.jpg
case_images: PMC6737447_01_JCIS-9-39-g001.jpg
case_images: F1
case_images: The CTA showed a codominant coronary artery system with severe diffuse atherosclerosis [Figure 1].
case_images: A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Computed tomography-derived fractional flow reserve (FFRct) report. Numbers indicate FFRct readings 15 mm distal to the stenoses in the left main (LM) coronary artery and right coronary artery (RCA), respectively, corresponding to the blue arrows in Figure 1. The FFRct value was <=0.75 in the distal LM, proximal left anterior descending coronary artery, and proximal left circumflex coronary artery, whereas it was 0.86 in the ramus. The FFRct value in the RCA was normal.
case_images: JCIS-9-39-g002.jpg
case_images: PMC6737447_01_JCIS-9-39-g002.jpg
case_images: F2
case_images: The patient was referred to ICA, and as an adjunctive test to elucidate the hemodynamic significance of the suspected stenosis in the RCA, an FFRct was ordered at HeartFlow (Redwood City, CA, U.S.A.) [Figure 2].
case_images: A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Invasive coronary angiography. Left: Right coronary artery which is without coronary stenosis. Right top: Left anterior descending coronary artery with moderate elongated stenosis (red arrow). The ramus and left circumflex coronary artery are without coronary stenosis. Right bottom: Left main coronary artery with distal moderate stenosis (red arrow). Blue arrow: Points of FFR measurements.
case_images: JCIS-9-39-g003.jpg
case_images: PMC6737447_01_JCIS-9-39-g003.jpg
case_images: F3
case_images: No stenosis was present in the LCX [Figure 3].