To the Editor:
We thank Muñoz García et al for their interest in our article.1 I found their contribution to be timely and interesting, as it reports the experiences of a centre using the pressure guidewire to evaluate intermediate trunk lesions. This group possesses recognised experience in using this diagnostic technique.
I would like to highlight a few aspects related to this study and our own, beginning with the applicability of these strategies. An angiographic reading of an intermediate degree of stenosis is not sufficient; rather, there should be no doubt as to the "guilt" of the lesion (resolved by the ECG and ischemia testing).
Secondly, it is essential that the study be well-elaborated, whether using intracoronary ultrasound (ICUS), which guarantees proper visualisation of the entire trajectory up to the aortoostial union, or with a pressure guidewire, preferably using intravenous adenosine in the ostial lesions, and in sufficiently high doses if by the intracoronary method. Some studies have shown that intracoronary adenosine infusion does not attain the maximum hyperaemic state2,3 and that, as the team in Murcia has shown,4 only doses much higher than those initially recommended (>60 µg) achieve that effect.
Finally, with respect to the technique to be used, one should use that with which he or she is most familiar and experienced. According to publications, the cut-off value for the ICUS would be 6 mm2 of the luminal area. Nevertheless, there are particular situations in which one technique or another might be preferable, such as cases of morphologically complex defects or those in which "artefacts" are suspected (bifurcations, ostium, calcifications) where ICUS might be more useful, or when percutaneous revascularisation is considered in the case of a significant defect, given that ICUS is of considerable help in guiding the process and assessing its results.