Focal or diffuse coronary disease: how can PPG measurement contribute to clinical decision-making?

How can physiology guide treatment decisions beyond ischemia detection? In this round-table recorded at EuroPCR 2025, Thomas Engstrøm, Carlos Collet and Jeroen Sonck examine how pullback pressure gradient (PPG) makes it possible to identify the distribution pattern of coronary artery disease—focal or diffuse—based on a continuous scale from 0 to 1. This distinction matters: up to one third of patients present with diffuse disease, a form that poses significant challenges for PCI and often leads to suboptimal results.

They also highlight how PPG can be used alongside intravascular imaging to reveal plaque characteristics—lipidic in focal disease, calcified in diffuse disease—and how this combination enhances decision-making.

While FFR remains essential to detect ischemia, PPG brings an added layer of insight by revealing how it is distributed along the vessel.

This interview was filmed at EuroPCR 2025: see more videos here.