Variability of coronary flow reserve obtained immediately after coronary angioplasty

Popma, Jeffrey J.; Dehmer, Gregory J.; Eichhorn, Eric J.

doi:10.1007/bf01798430

Cited by 9 publications

(2 citation statements)

References 24 publications

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“…Multiple studies have shown, that coronary flow reserve after PTCA is improved but in most patients not normalized [140,180,181,251]. Multiple explanations have been put forward in order to explain this surprising finding which has to be interpreted in view of angiographically optimal results on the one hand and the frequent CK elevation on the other hand.…”

Section: Mkroembofization Durÿ Coronary Interventionsmentioning

confidence: 99%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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The diagnosis coronary artery disease is classically based on patient's symptoms and morphology, as analyzed by angiography. The importance of risk factors for the development of coronary atherosclerosis and disturbance of coronary vasomotion is clearly established. However, microembolization of the coronary circulation has also to be taken into account. Microembolization may occur as a single or as multiple, repetitive events, and it may induce inflammatory responses. Spontaneous microembolization may occur, when the fibrous cap of an atheroma or fibroatheroma (Stary i.v. and Va) ruptures and the lipid pool with or without additional thrombus formation is washed out of the atheroma into the microcirculation. Such events with progressive thrombus formation are known as cyclic flow variations. Plaque rupture occurs more frequently than previously assumed, i.e. in 9% of patients without known heart disease suffering a traffic accident and in 22% of patients with hypertension and diabetes. Also, in patients dying from sudden death microembolization is frequently found. Patients with stable and unstable angina show not only signs of coronary plaque rupture and thrombus formation, but also microemboli and microinfarcts, the only difference between those with stable and unstable angina being the number of events. Appreciation of microembolization may help to better understand the pathogenesis of ischemic cardiomyopathy, diabetic cardiomyopathy and acute coronary syndromes, in particular in patients with normal coronary angiograms, but plaque rupture detected by intravascular ultrasound. Also, the benefit from glycoprotein IIb/IIIa receptor antagonist is better understood, when not only the prevention of thrombus formation in the epicardial atherosclerotic plaque, but also that of microemboli is taken into account. Microembolization also occurs during PTCA, inducing elevations of troponin T and I and elevations of the ST segment in the EKG. Elevated baseline coronary blood flow velocity, as a potential consequence of reactive hyperemia in myocardium surrounding areas of microembolization, is more frequent in patients with high frequency rotablation than in patients with stenting and in patients with PTCA. The hypothesis of iafrogenic microembolization during coronary interventions is now supported by the use of aspiration and filtration devices, where particles with a size of up to 700 microns have been retrieved. In the experiment, microembolization is characterized by perfusion-contraction mismatch, as the proportionate reduction of flow and function seen with an epicardial stenosis is lost and replaced by contractile dysfunction in the absence of reduced flow. The analysis of the coronary microcirculation, in addition to that of the morphology and function of epicardial coronary arteries, and in particular appreciation of the concept of microembolization will further improve the understanding of the pathophysiology and clinical symptoms of coronary artery disease.

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Section: Mkroembofization Durÿ Coronary Interventionsmentioning

confidence: 99%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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“…Coronary flow reserve has been demonstrated to improve in most patients immediately following PTCA [15][16][17]. However, in another group of unselected patients, no significant improvement of the coronary flow reserve was noted [18].…”

Section: Discussionmentioning

confidence: 99%

Improvement of coronary morphology and blood flow after stenting

Erbel

Zamorano

et al. 1995

Int J Cardiac Imag

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Intravascular ultrasound (IVUS) and intracoronary Doppler (ICD) were performed in eight patients (54.3 +/- 6.5 years, 6 male) immediately after PTCA and after stenting. ICD was also performed before PTCA. After PTCA, IVUS has demonstrated intimal rupture in all patients. After stenting, IVUS revealed wall wrapping of the intimal flap with a free lumen in all patients. The lumen diameter was 2.42 +/- 0.55 mm after PTCA and was 2.74 +/- 0.49 mm after stenting (p < 0.001). The cross-sectional area increased from 4.70 +/- 1.99 mm2 post-PTCA to 6.40 +/- 2.15 mm2 post-stent (p < 0.005). Coronary flow velocity reserve, calculated by the ratio of mean flow velocity at rest and after intracoronary papaverine administration, increased from 2.05 +/- 1.01 to 2.99 +/- 1.14 after PTCA (p = 0.015); and increased to 4.51 +/- 1.33 after stenting (p < 0.001). The morphological data derived from IVUS correlated with the functional information obtained with ICD. In addition to its established role in bail out situations, stent implantation may be considered when a suboptimal morphological and functional result has been demonstrated.

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Early changes in coronary flow physiology after balloon angioplasty or stenting: A 24‐hour Doppler flow velocity study

Dupouy

Aptecar

Pelle³

et al. 2002

Cathet Cardio Intervent

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To evaluate early changes in myocardial microcirculation after balloon or stent coronary angioplasty, we studied 57 patients undergoing coronary angioplasty with a Doppler-tipped guidewire, with (n = 26) or without stenting. Postprocedural quantitative coronary angiography and coronary flow velocity were measured after 10 min and 24 hr. As compared to stenting, no stenting was associated with a higher postprocedural stenosis rate (21% +/- 13% vs. 12% +/- 10%; P < 0.05), smaller coronary velocity reserve (CVR; 2.2 +/- 0.4 vs. 2.5 +/- 0.7; P = 0.04), and smaller relative CVR (0.8 +/- 0.2 vs. 1.1 +/- 0.3; P = 0.001). At 24 hr, CVR and relative CVR in the unstented group increased to the level in the stented group, mainly because of a decrease in basal average peak velocity (APV). Overall, there was a significant negative linear relation between CVR and APV variations during the 24-hr period. In the subgroups with persistent abnormalities, CVR variation was closely related to the basal APV/reference APV ratio. In conclusion, coronary reserve normalization can occur within 24 hr after coronary angioplasty and is closely dependent on postangioplasty APV. Myocardial distal resistances should be considered when interpreting postangioplasty CVR.

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Variability of coronary flow reserve obtained immediately after coronary angioplasty

Cited by 9 publications

References 24 publications

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Improvement of coronary morphology and blood flow after stenting

Early changes in coronary flow physiology after balloon angioplasty or stenting: A 24‐hour Doppler flow velocity study

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