Controversies in the Use of Fractional Flow Reserve Form Computed Tomography (FFR_CT) vs. Coronary Angiography

Purpose of Review: Invasive coronary angiography (ICA) is the gold standard for the anatomical assessment of coronary artery disease. In addition, it provides assessment to coronary physiology and myocardial blood flow through fractional flow reserve (FFR). Furthermore, invasive FFR provides a clear road map that helps in the management of suspected coronary artery disease patients especially if an intermediate coronary lesion is considered. Despite all these developments, this invasive technique carries its own risk. Non-invasive coronary assessment using coronary computed tomography angiography (CCTA) is now an established tool for the evaluation of coronary artery disease. Recent Findings: Recent technology allows the measurement of FFR using CCTA imaging. This technique was studied in a number of papers that confirmed its validity, accuracy, clinical utility and cost-effectiveness. However, this technique continues to have some challenges. In this paper, we will review the data related to this new promising technique as well as its clinical implications, limitations and challenges. Summary: FFRCT is a promising tool that will provide valuable clinical information needed in the management of multiple clinical scenarios. It is expected to grow further in the near future and have significant clinical impact once its clinical role is further defined and workflow is simplified.