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Fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) provide an important clinical tool to evaluate the hemodynamic significance of coronary lesions. However, these indices have major limitations. As these indices are meant to be surrogates of coronary flow, clinical scenarios such as aortic stenosis (with increased end-systolic and end-diastolic pressures) or atrial fibrillation (with significant beat-to-beat cardiac output variability) can have significant effect on the accuracy and reliability of these hemodynamic indices. Here, we provide a comprehensive evaluation of the pitfalls, limitations, and strengths of FFR and NHPRs in common clinical scenarios paired with coronary artery disease., Competing Interests: Disclosure Dr D.M. Tehrani reports no disclosures. Dr A.H. Seto has received research grants from Philips and Acist, consulting fees from Medtronic and Medicure, and is a speaker for Terumo, General Electric, and Janssen, (Copyright © 2022 Elsevier Inc. All rights reserved.)

Coronary complications are increasingly rare but remain fatal if not managed promptly and effectively. We review the incidence, management, and prevention of the most serious coronary complications including acute vessel closure from dissection, no-reflow, thrombosis, and air embolism as well as mechanical complications including perforation, stent dislodgment, and atherectomy burr entrapment., Competing Interests: Disclosure Dr D.M. Tehrani has no disclosures. Dr A.H. Seto has research grants from Philips and Acist, honoraria from Janssen, Acist, Terumo, and consulting fees from Medicare and Medtronic., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Instantaneous wave-free ratio (iFR) is a vasodilator-free index of coronary blood flow used for revascularization decision-making. iFR-based revascularization also had a decreased rate of adverse effects from vasodilators, shorter procedure times, and lower revascularization rates. iFR-pullback predicts post-percutaneous coronary intervention physiologic outcomes in tandem and diffuse coronary lesions. iFR may be particularly useful in patients with potential adenosine resistance, contraindications to adenosine, and multivessel or serial lesions. iFR is a useful tool both with and without fractional-flow reserve for revascularization planning., (Published by Elsevier Inc.)

Coronary hemodynamic measurements provide a critical tool to assess the ischemic potential of coronary stenoses. Fractional flow reserve (FFR) is a reliable method to relate translesional coronary pressures to hyperemic myocardial blood flow. Although a basic understanding in FFR can be quickly achieved, many of the nuances and potential pitfalls require special attention. The authors discuss the practical setup of coronary pressure measurement, the most common pitfalls in technique and ways to avoid them, and the limitations of available pharmacologic hyperemic methods., (Published by Elsevier Inc.)