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FFRangio

Summary

FFRangio is a wire-free, noninvasive computational tool used to estimate fractional flow reserve (FFR) in patients with coronary artery disease. It reconstructs a three-dimensional model of the coronary arteries from standard coronary angiography and applies physics-based or machine learning-enabled flow simulations to estimate pressure gradients. By eliminating the need for invasive pressure wires and hyperemia-inducing agents, it aims to streamline physiological lesion assessment during routine clinical workflows.

Description

Physiological assessment using invasive pressure wires is the gold standard for guiding percutaneous coronary intervention (PCI) but remains underused in clinical practice due to procedural complexity, cost, and patient discomfort. FFRangio addresses these limitations by utilizing image-derived anatomy from standard coronary angiography to predict pressure-based indices.

The method exploits the relationship between coronary geometry and pressure loss under maximal vasodilation (hyperemia) conditions. Specifically, it: 1. Reconstructs a 3D model of the coronary artery tree from 2D angiographic views. 2. Applies computational fluid dynamics (CFD) or machine learning-derived flow models to estimate pressure drops across coronary stenoses. 3. Calculates a simulated FFR value to identify ischemia-producing lesions.

Clinical Validation

In the multicenter, randomized, noninferiority ALL-RISE (Advancing Cath Lab Results with FFRangio Coronary Physiology Assessment) trial, an FFRangio-guided strategy was shown to be noninferior to a traditional pressure wire-guided strategy at 1 year (as of 2026-07-19). FFRangio-guided assessment was associated with: * Shorter procedural times * Lower radiation exposure for patients and staff * Reduced contrast agent use

A similar concurrent trial by Daemen et al. also validated the clinical utility and safety of angiography-derived FFR.

Citations

  • Randles A. Physiological Assessment of Coronary Artery Disease. N Engl J Med 2026;395:80-83. NEJMe2602134.pdf
  • Fearon WF, Jeremias A, Witberg G, et al. Angiography-derived fractional flow reserve to guide PCI. N Engl J Med 2026;395:9-19.
  • Daemen J, van der Eijk JA, Barbierato M, et al. Angiography-based physiology to guide coronary revascularization. N Engl J Med 2026;395:20-31.