Гибридный подход к введению натрия аденозинтрифосфата для достижения максимальной гиперемии при оценке фракционного резерва кровотока у пациентов с умеренной степенью стеноза коронарных артерий

Hybrid approach to sodium adenosine triphosphate administration for achieving maximum hyperemia during fractional flow reserve assessment in patients with moderate coronary artery stenosis

The introduction of fractional flow reserve (FFR) into clinical practice has significantly improved the diagnostics of coronary artery disease (CAD). FFR is the difference in pressure gradient between the aorta and distal coronary vessel and is used to assess the hemodynamic significance of moderate coronary stenoses. Inserting a special manometric conductor behind the stenosis allows measuring FFR values at the peak of maximum hyperemia. To achieve this condition, it is necessary to administer a special pharmacological drug – a hyperemic agent, which can be administered either intracoronarily or intravenously. Today, the most effective hyperemic agents are considered to be adenosine, adenosine triphosphate, papaverine and contrast agents. Numerous clinical trials have proven their effectiveness and safety. However, each of these drugs has its own pharmacological features that must be taken into account when using them. The traditional hyperemia induction method is still the gold standard for determining the FFR index, although it has some limitations that can lead to false-positive FFR results. Combining two hyperemic agents or a hybrid approach using the same agent to achieve maximal hyperemia significantly improves the accuracy of FFR measurements, allowing a more accurate assessment of the hemodynamic significance of intermediate coronary stenoses. We present a clinical case of successful application of the hybrid adenosine triphosphate administration technique for induction of maximum hyperemia in patients with moderate coronary artery stenoses. © Х.Ф. Хабибиллаев, З.Х. Шугушев, 2025