Comparison of Myocardial Perfusion Reserve Before and After Coronary Balloon Predilatation and After Stent Implantation in Patients With Postangioplasty Restenosis

Haude, Michael; Caspari, Guido; Baumgart, Dietrich; Brennecke, R.; Meyer, J.; Erbel, Raimund

doi:10.1161/01.cir.94.3.286

Cited by 50 publications

(42 citation statements)

References 46 publications

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“…Relative flow reserve has been determined previously in absolute flow terms 14,27 as well as by use of densitometric parameters 17 and has correlated well with PET measurements and percent area stenosis. RFVR correlates much more closely than poststenotic CVR to stenosis severity within a wide range of percent area stenoses.…”

Section: Cvr Versus Rfvrmentioning

confidence: 88%

Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve

et al. 1998

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Background-Myocardial fractional flow reserve (FFR) is based on pressure measurements. We have now sought to establish a Doppler-based concept of relative flow velocity reserve (RFVR) for the functional assessment of stenosis severity in epicardial coronary arteries. A clear threshold value to discriminate the functional severity of a coronary stenosis does not exist for coronary flow velocity reserve (CVR) based on intracoronary Doppler measurements. In contrast, the concept of FFR, which is based on intracoronary pressure measurements, has been extensively validated. An FFR value below 0.75 reliably indicates a significant stenosis. Methods and Results-RFVR is calculated as the ratio between distal CVR in the stenosed target vessel and distal CVR in a nonstenotic reference vessel. In 21 patients, RFVR was determined in 24 target vessels by use of intracoronary adenosine and correlated to the FFR, determined as the ratio of mean poststenotic to aortic pressures, in the target vessel. Stenosis severity was classified according to quantitative coronary angiography analysis. Reference diameter was 3.0Ϯ0.4 mm (meanϮSD), and area stenosis was 74Ϯ15% (range, 40% to 95%). CVRs in the target and reference vessels were 2.1Ϯ0.5 and 2.6Ϯ0.

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Section: Cvr Versus Rfvrmentioning

confidence: 88%

Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve

et al. 1998

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“…After additional loading with clopidogrel (600 mg oral) and heparin (10.000 IU iv) coronary angiography was performed using the femoral approach and 6-Fr or 8-Fr guiding catheters. Stenosis severity was quantified using off-line caliper measurements (QCA-MEDIS, Leiden, The Netherlands) (13), and thrombolysis in myocardial infarction (TIMI) flow was measured before and after stent implantation (41).…”

Section: Methodsmentioning

confidence: 99%

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

Kleinbongard

Baars

Möhlenkamp

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Kleinbongard P, Baars T, Möhlenkamp S, Kahlert P, Erbel R, Heusch G. Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris. Am J Physiol Heart Circ Physiol 305: H1222-H1229, 2013. First published August 9, 2013; doi:10.1152/ajpheart.00358.2013.-Stent implantation into atherosclerotic coronary arteries releases particulate debris and soluble substances that contribute to impaired microvascular perfusion. Here we addressed the potential for microvascular obstruction in patients with stenotic native right coronary arteries (nRCA) compared with saphenous vein grafts on right coronary arteries (SVG-RCA). We enrolled symptomatic, male patients with stable angina pectoris and a flow-limiting stenosis in their nRCA or SVG-RCA (n ϭ 18/18). Plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Coronary aspirate was retrieved during stent implantation under protection with a distal occlusion/aspiration device and divided into particulate debris and plasma. The release of catecholamines, endothelin, serotonin, thromboxane B2, and tumor necrosis factor-␣ was measured. The response of rat mesenteric arteries with intact (ϩE) and denuded (ϪE) endothelium to aspirate plasma (without and with selective endothelin receptor blockade) was normalized to that by potassium chloride (KClmax ϭ 100%). Plaque volume and composition were not different between nRCA and SVG-RCA. There was less particulate debris (65 Ϯ 8 vs. 146 Ϯ 23 mg; P Ͻ 0.05) and more endothelin release (5.8 Ϯ 0.8 vs. 1.3 Ϯ 0.7 pg/ml; P Ͻ 0.05) in nRCA than in SVG-RCA, whereas the release of the other mediators was not different. Aspirate from nRCA induced stronger vasoconstriction than that from SVG-RCA [nRCA, 78 Ϯ 6% (ϩE)/84 Ϯ 5% (ϪE); SVG-RCA, 59 Ϯ 6% (ϩE)/68 Ϯ 3% (ϪE); P Ͻ 0.05 nRCA vs. SVG-RCA], which was attenuated by a nonspecific endothelin and a specific endothelin receptor A antagonist. Thus coronary aspirate from stented nRCA is characterized by less debris but more endothelin and stronger vasoconstrictor response than that from SVG-RCA. coronary disease; ischemia; native coronary artery; saphenous vein graft; vasoconstriction INTERVENTIONAL PLAQUE RUPTURE induces the release of not only particulate debris but also soluble vasoconstrictor, thrombogenic, and inflammatory substances from the lesion that all contribute to impair microvascular coronary perfusion. Typical consequences of coronary microvascular obstruction are microinfarcts with subsequent inflammation, arrhythmias, contractile dysfunction, and impaired coronary flow reserve (14). Various protection devices have been used to capture and remove the released plaque material. A prognostic benefit from distal protection devices in elective interventions has been established only for saphenous vein grafts (SVGs) (3, 39), whereas a benefit for native coronary arteries still remains to be demonstrated (14).The underlying atherosclerosis in native coronary arteries differs from that in SVGs,...

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“…7,8 All patients received either ticlopidine (500 mg/d) or clopidogrel (75 mg/d, 300 mg as loading dose) for 4 weeks in addition to continued aspirin medication (100 mg/d).…”

Section: Coronary Interventionmentioning

confidence: 99%

Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

et al. 2002

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Background-Stenting-related myocardial injury has been recognized as a frequent and prognostically important event, the extent of which depends on microcirculatory impairment in association with platelet aggregation, inflammation, and increased oxidative stress. Recent studies underscored the non-lipid-lowering effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) with antithrombotic, antiinflammatory, and antioxidative aspects. Thus, we tested the hypothesis that preprocedural statin therapy is associated with a reduction in the extent of stenting-related myocardial injury. Methods and Results-We stratified 296 consecutive patients who were undergoing stenting of a de novo stenosis according to the preprocedural status of statin therapy (229 statin-treated and 67 control patients). Incidence of periprocedural myocardial injury was assessed by analysis of creatine kinase (CK; upper limit of normal [ULN] 70 IU/L for women, 80 IU/L for men) and cardiac troponin T (cTnT; bedside test; threshold 0.1 ng/mL) before and 6, 12, and 24 hours after the intervention. Relative to control patients, the incidence of CK elevation Ͼ3ϫ ULN was more than 90% lower in statin-treated patients (0.4% versus 6.0%, Pϭ0.01). Statin therapy was the only factor independently associated with a lower risk of CK elevation Ͼ3ϫ ULN (OR: 0.08, 95% CI: 0.01 to 0.75; Pϭ0.03). The overall incidences of CK and cardiac troponin T elevation were slightly lower in statin-treated than in control patients (14.4% versus 20.9%, Pϭ0.3, and 17.9% versus 22.4%, Pϭ0.5, respectively). Conclusions-Preprocedural statin therapy is associated with a reduction in the incidence of larger-sized, stenting-related myocardial infarctions. Prospective, randomized trials are warranted to further assess this cardioprotective effect of statins in coronary intervention.

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Comparison of Myocardial Perfusion Reserve Before and After Coronary Balloon Predilatation and After Stent Implantation in Patients With Postangioplasty Restenosis

Cited by 50 publications

References 46 publications

Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve

Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

Preprocedural Statin Medication Reduces the Extent of Periprocedural Non–Q-Wave Myocardial Infarction

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