TY - JOUR
T1 - Abnormal coronary flow velocity reserve after coronary artery stenting in patients
T2 - Role of relative coronary reserve to assess potential mechanisms
AU - Kern, Morton J.
AU - Puri, Sanjeev
AU - Bach, Richard G.
AU - Donohue, Thomas J.
AU - Dupouy, Patrick
AU - Caracciolo, Eugene A.
AU - Craig, W. Randall
AU - Aguirre, Frank
AU - Aptecar, Eduardo
AU - Wolford, Thomas L.
AU - Mechem, Carol J.
AU - Dubois-Rande, Jean Luc
PY - 1999/12/21
Y1 - 1999/12/21
N2 - Background - Absolute coronary flow velocity reserve (CVR) after stenting may remain abnormal as a result of several different mechanisms. Relative CVR (rCVR=CVR(target)/CVR(reference)) theoretically normalizes for global microcirculatory disturbances and facilitates interpretation of abnormal CVR. Methods and Results - To characterize potential mechanisms of poststent physiology, CVR was measured using a Doppler-tipped angioplasty guidewire in 55 patients before and after angioplasty, after stenting, and in an angiographically normal reference vessel. For the group, the percent diameter stenosis decreased from 75±13% to 40±18% after angioplasty and to 10Å9% (all P<0.05) after stent placement. After angioplasty, CVR increased from 1.63±0.71 to 1.89±0.55 (P<0.05) and after stent placement, to 2.48±0.75 (P<0.05 versus pre- and postangioplasty). After angioplasty, rCVR increased from 0.64±0.26 to 0.75±0.23 and after stent placement to 1.00±0.34. In 17 patients with CVR(stent) ≤2.0, increased basal coronary flow, rather than attenuated hyperemia, was responsible in large part for the lower CVR(stent) compared with patients having CVR(stent) >2.0. In 8 patients with CVR(stent) <2.0, a normal rCVR supported global microvascular disease. The subgroup of 9 patients with CVR(stent) <2.0 and abnormal rCVR (16% of the studied patients) may require a pressure-derived fractional flow reserve to differentiate persistent obstruction from diffuse atherosclerotic disease or microvascular stunning. Conclusions - Although a majority of patients after stenting normalize CVR for the individual circulation (ie, normal CVR or normal rCVR), in those with impaired CVR(stent), the analysis of coronary flow dynamics suggests several different physiological mechanisms. Additional assessment may be required to fully characterize the physiological result for such patients to exclude remediable luminal abnormalities.
AB - Background - Absolute coronary flow velocity reserve (CVR) after stenting may remain abnormal as a result of several different mechanisms. Relative CVR (rCVR=CVR(target)/CVR(reference)) theoretically normalizes for global microcirculatory disturbances and facilitates interpretation of abnormal CVR. Methods and Results - To characterize potential mechanisms of poststent physiology, CVR was measured using a Doppler-tipped angioplasty guidewire in 55 patients before and after angioplasty, after stenting, and in an angiographically normal reference vessel. For the group, the percent diameter stenosis decreased from 75±13% to 40±18% after angioplasty and to 10Å9% (all P<0.05) after stent placement. After angioplasty, CVR increased from 1.63±0.71 to 1.89±0.55 (P<0.05) and after stent placement, to 2.48±0.75 (P<0.05 versus pre- and postangioplasty). After angioplasty, rCVR increased from 0.64±0.26 to 0.75±0.23 and after stent placement to 1.00±0.34. In 17 patients with CVR(stent) ≤2.0, increased basal coronary flow, rather than attenuated hyperemia, was responsible in large part for the lower CVR(stent) compared with patients having CVR(stent) >2.0. In 8 patients with CVR(stent) <2.0, a normal rCVR supported global microvascular disease. The subgroup of 9 patients with CVR(stent) <2.0 and abnormal rCVR (16% of the studied patients) may require a pressure-derived fractional flow reserve to differentiate persistent obstruction from diffuse atherosclerotic disease or microvascular stunning. Conclusions - Although a majority of patients after stenting normalize CVR for the individual circulation (ie, normal CVR or normal rCVR), in those with impaired CVR(stent), the analysis of coronary flow dynamics suggests several different physiological mechanisms. Additional assessment may be required to fully characterize the physiological result for such patients to exclude remediable luminal abnormalities.
KW - Blood flow
KW - Coronary disease
KW - Stenosis
KW - Stents
UR - http://www.scopus.com/inward/record.url?scp=0033613542&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.100.25.2491
DO - 10.1161/01.CIR.100.25.2491
M3 - Article
C2 - 10604886
AN - SCOPUS:0033613542
SN - 0009-7322
VL - 100
SP - 2491
EP - 2498
JO - Circulation
JF - Circulation
IS - 25
ER -