How should I treat a patient with typical angina, typical angiography, negative FFR?

BACKGROUND

A 63-year-old man was referred for cardiac catheterisation for typical angina. At angiography, high-grade stenosis of the first diagonal branch, of the proximal circumflex and of an intermediate branch was found. After treatment of the diagonal branch, fractional flow reserve of the circumflex and intermediate branch was negative, but symptoms persisted.

INVESTIGATION: Physical examination, laboratory test, stress echocardiography, fractional flow reserve, coronary flow reserve.

DIAGNOSIS: Complex interaction between epicardial stenosis and microvascular hyporeactivity.

MANAGEMENT: Stenting.