Curr Treat Options Cardio Med (2017) 19: 13 DOI 10.1007/s11936-017-0514-x Coronary Artery Disease (D Feldman and V Voudris, Section Editors) Practical Considerations of Fractional Flow Reserve Utilization to Guide Revascularization Tara Shah, MD 1,* Joshua D. Geleris, MD 2 Joshua Schulman-Marcus, MD FACC 3 Dmitriy N. Feldman, MD FACC 1 Rajesh V. Swaminathan, MD FACC 4 Address *,1 Department of Medicine, Greenberg Division of Cardiology, New York Presbyte- rian Hospital-Weill Cornell Medicine, 520 East 70th Street, Starr-434 Pavilion, New York, NY, 10021, USA Email: tas2012@nyp.org 2 Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA 3 Division of Cardiology, Albany Medical Center, 47 New Scotland Ave, MC-44, Albany, NY, 12208, USA 4 Duke Clinical Research Institute, Duke University Medical Center, 508 Fulton Street (A3014), Durham, NC, 27705, USA Published online: 9 March 2017 * Springer Science+Business Media New York 2017 This article is part of the Topical Collection on Coronary Artery Disease Keywords Invasive angiography I Coronary artery disease I Fractional flow reserve I Stenosis Opinion statement Invasive angiography has long been the gold standard for the diagnosis of obstructive coronary artery disease (CAD). However, the relationship between angiographic measures of stenosis and coronary blood flow is complex, and there is frequent discordance between the visual assessment of a stenotic lesion and its effect on myocardial perfusion. Fractional flow reserve is a rapidly emerging invasive means of assessing the physiologic significance of an epicardial stenosis. This review provides a pragmatic understanding of the physio- logic principles that guide fractional flow reserve (FFR), sheds light on its nuances, and explores the most landmark investigations. We will also discuss how the measurement of FFR can be helpful or limiting in several common clinical situations.