© 2015. Volcano Corporation. Content is proprietary and confidential. 600 - 0100.136/002 1 An Introduction to iFR Scout™ Pullback Measurements
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An Introduction to iFR Scout™ Pullback Measurements Moving from Justified PCI to Guided PCI iFR® is a registered trademark of Volcano Corporation iFR Scout™ is a trademark of Volcano Corporation © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002

From Justification… Historically, a distal FFR or iFR value would be used to justify stenting this LAD with multiple lesions • Where should the stent be placed? • How many stents will you need? • Was normal blood flow returned? Nijjer S, et al. “Pre-Angioplasty Instantaneous Wave-Free Ratio (iFR) Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease. JACC: Cardiovascular Interventions 2014; 12: 1386-1396. 2 © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002

From Justification… FFR can be used to make pullback measurements, but is seldom used. Why? Requires IV hyperemia Can be difficult to interpret Requires an additional FFR pullback assessment after treating the first lesion to assess the “updated” severities of the remaining two lesions Requires hyperemia for a final “post” FFR assessment to document success “Serial Lesion FFR Made Simple.” www.cathlabdigest.com. Web. January 20, 2015 Nijjer S, et al. “Pre-Angioplasty Instantaneous Wave-Free Ratio (iFR) Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial...

…to Guidance iFR pullback assessments map the ischemic contribution of each lesion without the confounding effect observed with FFR pullback assessments, providing guidance in the determination of a treatment plan • Faster without IV hyperemic agents (pre- or post- PCI) • Easier without interim reassessments as each lesion is treated Adapted from Nijjer S, et al. “Pre-Angioplasty Instantaneous Wave-Free Ratio (iFR) Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease. JACC: Cardiovascular Interventions 2014; 12:...

Assessing Diffuse Disease What should I do? 1.0 0.83 Scenario 1: Diffuse Disease 0.83 Scenario 2: Focal Disease Would this change your treatment strategy? Simulated case for educational purpose 5 © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002

Is there is a focal lesion(s) that can be treated? Simulated case for educational purpose 6 © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002 Was the ischemia resolved? Document the results

iFR Scout™ Pullback Software • Provides the benefits of pullback measurements without the need for hyperemia • Significant features • Pullback assessment of multiple lesions • Live display of singlecycle iFR value • Highlighting of the WaveFree Period iFR Scout Operator’s Manual, 505-0101.27 7 © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002

The iFR Scout™ Interface: Live Waveforms Procedure Date on all Screens Live Single-Cycle iFR Value Start iFR Pullback Measurement © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002 Make iFR Spot Measurement

The iFR Scout™ Interface: Results Pullback Plot Trend Line (never goes down, left to right) Raw Line (actual singlecycle iFR values) Distal iFR Value Automatic “Pullback” Annotation Trend Line Navigation Slider © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002

© 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002

Closing • With the addition of iFR Scout pullback measurement capability, Volcano’s iFR modality helps moves physiology from physiologic justification to physiologic guidance • iFR Scout may be useful for assessing serial lesions and diffuse disease as well as for documenting treatment results, without the need for a hyperemic agent © 2015. Volcano Corporation. Content is proprietary and confidential. 600-0100.136/002