GMH

55 years old male with chest pain on exertion. Treated medically by 1st Cardiologist. Subsequently cardiac catheterization reported mid LAD 50% stenosis plaque rupture and stented. Post stenting FFR 0.83. Symptoms relieved 1 month. After recurrence, sought alternative opinion.Repeat cardiac catheterization 6 months later, similar FFR findings, FFR 0.83. New analysis with QFR 0.63.There is a residual 50% stenosis at the proximal segment.Should it be stented. Is the chest pain related to FFR

6Fr IL 3.5, Right radial approach. Standard CAG and FFR with IC adenosine challengeLeft main large and normal and longLAD large with stenosis at proximal and mid segmentRamus intermediate is largeLCX is large and normalRight dominant circulation with minor irregularitiesRadiwire system advanced beyond LAD with heparin coverIC adenosine challenge with employment of iFRiFR was 0.91 at baseline and 0.87 on pullbackFFR was 0.94 at baseline and 0.83 after maximum hyperemia challengeQFR system using Braun system

Conflicting results and patient symptoms lead to challenging decisions.Option 1), to stent the proximal LAD with no assurance of improvement of FFR and QFR2) Symptoms correlate with functional tests? This is another challenging questionThis case is presented for expert opinion on the best care for patient.