The effect of coronary angioplasty on coronary flow reserve.

Abstract

To determine the effects of coronary angioplasty on coronary flow reserve (CFR), we studied 32 patients before and immediately after single-vessel coronary angioplasty and 31 patients evaluated late after angioplasty (7.5 + 1.2 months, mean + SEM). The geometry (percent area stenosis and minimal cross-sectional area) of each lesion was determined by quantitative coronary angiography (Brown/Dodge method) and the integrated optical density was measured by videodensitometry. CFR was measured with a No. 3F coronary Doppler catheter placed immediately proximal to the lesion and a maximally vasodilating dose of intracoronary papaverine. The translesional pressure gradient was obtained in all lesions before and immediately after angioplasty and in 18 of 31 vessels late after angioplasty. CFR immediately after angioplasty returned to normal levels (> 3.5 peak/resting velocity ratio) in 14 of 31 patients and was improved, although not normalized, in the remaining 17 patients. CFR immediately after dilation was not significantly correlated with any of the angiographic variables of arterial stenosis nor the resting pressure gradient. Moreover, the pressure gradient and absolute distal coronary pressure at peak hyperemia were not significantly different in vessels with normal and those with abnormal flow reserve immediately after dilation, suggesting that the residual stenosis did not significantly limit hyperemia. Late after angioplasty, however, a significant relationship emerged between CFR and all four indexes of residual arterial stenosis (percent area stenosis r = .70, p < .01; minimum arterial cross-sectional area r = .70, p < .01; integrated optical density r = .60, p < .01; and translesional pressure gradient r = .77, p < .01). Furthermore, in the absence of restenosis, CFR eventually normalized in all patients. These findings demonstrate that in one-half of patients there is a transient reduction in coronary flow reserve immediately after angioplasty. In the absence of restenosis, coronary flow reserve later normalizes. Consequently, measurements of coronary flow reserve immediately after angioplasty may not reflect the eventual success of the procedure in removing physiologic obstruction to coronary blood flow. Circulation 77, No. 4, 873-885, 1988. ALTHOUGH coronary angioplasty has been shown to increase coronary luminal cross-sectional area,1 reduce the translesional pressure gradient,2 ameliorate the symptoms of myocardial ischemia,3' 4and normalize previously positive noninvasive studies of provokable myocardial ischemia (e.g., exercise electrocardiographic,3' thallium-201 scintigraphic,4 and diastolic

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

“…In agreement with several studies, [5][6][7] we found an elevation of baseline APV as a contributing factor for a low postproce- *Variables include age, sex; and a history of diabetes, hypertension, smoking, previous MI, or revascularization. Functional angina class; baseline heart rate, systolic blood pressure, and diameter stenosis; and lesion characteristics (angulation, calcification, bifurcation, and contour) were not independent predictors.…”

Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance

“…There are indications, however, that the myocardial microvasculature can be affected by the invasive procedure itself. 19 Therefore, another confounding factor was introduced, making the conclusions from these studies debatable. In our protocol, such confounding is prevented by performing all measurements after stent placement.…”

Assessment of Coronary Arterial Restenosis With Phase-Contrast Magnetic Resonance Imaging Measurements of Coronary Flow Reserve

“…[1][2][3] The restenotic lesion may impair coronary blood flow, reduce coronary arterial flow reserve (CAFR), limit exercise tolerance, and precipitate chest pain. 4,5 Most individuals who have chest pain in the months after a successful percutaneous intervention require contrast coronary angiography for the definitive identification of restenosis. 6,7 A noninvasive method for reliably identifying restenosis would have substantial clinical utility.…”