Role of Coronary Artery Lumen Enlargement in Improving Coronary Blood Flow After Balloon Angioplasty and Stenting: A Combined Intravascular Ultrasound Doppler Flow and Imaging Study

Kern, Morton J.; Dupouy, Patrick; Drury, John H.; Aguirre, Frank V.; Aptecar, Eduardo; Bach, Richard G.; Caracciolo, Eugene A.; Donohue, Thomas J.; Randé, Jean-Luc Dubois; Geschwind, H; Mechem, Carol; Kane, G.; Teiger, Emmanuel; Wolford, Thomas

doi:10.1016/s0735-1097(97)00082-x

Cited by 105 publications

(53 citation statements)

References 36 publications

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“…The latter has been previously reported, thus underscoring the important role of luminal enlargement for the achievement of an adequate CFVR after balloon angioplasty. 6,14 We found a significant relationship between the target and the reference artery CFVR after stent implantation, further supporting the concept of a strong influence exerted by the microcirculation on the postprocedural CFVR results. Therefore, a combination of microvascular dysfunction and the severity of the residual stenosis seem to explain a suboptimal CFVR result after angioplasty.…”

Section: Determinants Of Impaired Cfvr After Angioplastysupporting

confidence: 68%

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

et al. 2002

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Background-Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. Methods and Results-As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (Ն2.5 or Ͻ2.5) at the end of the procedure. A CFVR Ͻ2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR

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Section: Determinants Of Impaired Cfvr After Angioplastysupporting

confidence: 68%

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

et al. 2002

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“…However, the Doppler flow velocity patterns may indicate a significant residual stenosis, despite an angiographically insignificant appearance. 23 The remaining 5 of the 15 type 1 cases demonstrated type 2 TIMI 2 flow after the release of the residual stenosis by additional stenting, which is consistent with persistent microvascular damage. This result suggests that, in cases with a significant epicardial coronary stenosis combined with microvascular dysfunction in AMI, the epicardial coronary stenosis may be the main limiting factor of the coronary flow pattern and that microvascular dysfunction might be concealed.…”

Section: Timi 2 Flow After Balloon Angioplastymentioning

confidence: 65%

“…Although the degree of coronary artery stenosis was assessed by quantitative angiography in the present study, the limitations of angiography in determining the percent diameter stenosis after intervention are well known. 23 Thrombus in the culprit lesion makes it more difficult to estimate the degree of stenosis correctly in the acute period. Also, the study patients were limited to those with anterior AMI.…”

Section: Study Limitationsmentioning

confidence: 99%

Relation of Phasic Coronary Flow Velocity Characteristics With TIMI Perfusion Grade and Myocardial Recovery After Primary Percutaneous Transluminal Coronary Angioplasty and Rescue Stenting

et al. 2000

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Background-A residual stenosis and/or microvascular damage have been proposed as mechanisms of TIMI 2 flow for acute myocardial infarction. Coronary flow dynamics were assessed in patients with TIMI 2 flow to predict whether additional intervention would improve TIMI grade. Methods and Results-In 35 patients who had a successfully recanalized anterior acute myocardial infarction using angioplasty or rescue stenting, coronary flow patterns were compared with corresponding TIMI grade and regional left ventricular wall motion (LVWM) 1 month after the intervention. After angioplasty, the time-averaged peak velocity (APV) was lower in patients with TIMI 2 flow (nϭ22)

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“…26 However, IVUS analysis did not reveal a substantial difference in CSN either at the reference site or at the lesion site after the coronary procedure. Nevertheless, the higher initial plaque burden in patients with rCVR impairment must be taken into consideration for the outcome of both Doppler parameters and cardiac markers.…”

Section: Alternative Mechanisms Of Cvr Reductionmentioning

confidence: 84%

Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation

Herrmann¹,

Haude

Lerman³

et al. 2001

Circulation

124

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Background-Residual reduction of relative coronary flow velocity reserve (rCVR) after successful coronary intervention has been related to microvascular impairment. However, the incidence of cardiac enzyme elevation as a surrogate marker of an underlying embolic myocardial injury in these cases has not been studied. Methods and Results-A series of 55 consecutive patients with successful coronary stenting, periprocedural intracoronary Doppler analysis, and determination of creatine kinase (CK; upper limit of normal [ULN] for women 70 IU/L, for men 80 IU/L) and cardiac troponin T (cTnT; bedside test, threshold 0.1 ng/mL) before and 6, 12, and 24 hours after intervention were studied. Postprocedural rCVR was the only intracoronary Doppler parameter that independently correlated with cTnT (rϭϪ0.498, PϽ0.001) and CK outcome (rϭϪ0.406, Pϭ0.002). Receiver operating characteristic analysis identified a postprocedural rCVR of 0.78 as the best discriminating value, with a sensitivity of 83.3% and 69.2% and a specificity of 79.1% and 76.2% for detection of cTnT and CK elevation, respectively. Stratified according to this cutoff value, the incidence of cTnT elevation was 52.6% in patients with (nϭ19) and 5.6% in patients without (nϭ36) a postprocedural rCVR Ͻ0.78 (PϽ0.001), associated with a CK elevation Ͼ1 times the ULN in 36.8% and 5.6% (Pϭ0.005) of patients, respectively. Conclusions-Cardiac marker elevation can frequently be found after coronary procedures that are associated with a persistent reduction of rCVR, indicating procedural embolization of atherothrombotic debris with microvascular impairment and myocardial injury as a potential underlying mechanism.

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Role of Coronary Artery Lumen Enlargement in Improving Coronary Blood Flow After Balloon Angioplasty and Stenting: A Combined Intravascular Ultrasound Doppler Flow and Imaging Study

Cited by 105 publications

References 36 publications

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Relation of Phasic Coronary Flow Velocity Characteristics With TIMI Perfusion Grade and Myocardial Recovery After Primary Percutaneous Transluminal Coronary Angioplasty and Rescue Stenting

Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation

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