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During this #europcr 2025 round table, Thomas Engstrom, Carlos Collet and Jeroen Sonck explain how pullback pressure gradient (PPG) helps distinguish between focal and diffuse coronary artery disease—two distinct patterns with different implications for PCI. PPG quantifies disease distribution on a scale from 0 (diffuse) to 1 (focal), allowing clinicians not only to guide treatment but also to predict procedural outcomes in terms of blood flow improvement. Diffuse disease, which affects nearly one third of patients, poses greater challenges and often requires a different approach. They also highlight how combining PPG with intravascular imaging reveals differences in plaque composition—lipid-rich in focal lesions, calcified in diffuse disease. While FFR remains essential for identifying ischemia, they argue its use should extend to very severe lesions, with PPG providing complementary information on how ischemia is distributed. Watch the recording to explore how PPG is changing the way coronary physiology informs clinical care. Supported by Abbott More videos on PCRonline: https://www.pcronline.com/Cases-resou... #ppg, #pullbackpressuregradient, #focal, #diffuse, #coronaryarterydisease, #pci, #bloodflow, #intravascularimaging, #ischemia, #physiology