Part IX: Limitations of translesional pressure and flow velocity for long ostial left anterior descending stenoses

Abstract

Translesional pressure and flow velocity can be used to assess angiographically intermediate or indeterminate lesions. Ostial narrowings and long lesions represent situations that may require both pressure and flow velocity assessment. In patients with hypertension, diabetes mellitus, and chronic renal failure, distally measured absolute and regional coronary reserve values alone may not be helpful in selecting lesions requiring intervention.

Translesional pressure and flow velocity after thrombolysis: Assessment of suboptimal angioplasty for serial lesions

“…The velocity ratio value is most often helpful in the left coronary artery where branches serve to divert flow to regions of lower resistance. However, as noted before [ 5 ] , for ostial lesions in the left coronary artery, measurements of the proximal to distal velocity ratio to reflect an accurate gradient may not be suitable. The lesion significance in this case was confirmed by Coronary flow reserve was greater in the proximal than the distal regions in a stepwise fashion as measurements were made across the first three lesion zones.…”

“…the velocity is sampled [ 5 ] . In this patient, flow velocity proximal to the first lesion demonstrated a high value and probably reflected some acceleration due to the unappreciated ostial narrowing at the time of the first measurements.…”