Abnormal coronary flow velocity reserve after coronary artery stenting in patients - Role of relative coronary reserve to assess potential mechanisms

Article

关键词: BLOOD-FLOW;    BALLOON ANGIOPLASTY;    INTRAVASCULAR ULTRASOUND;    STENOSIS SEVERITY;    DISEASE;    IMPLANTATION;    PRESSURE;    ATHEROSCLEROSIS;    AUTOREGULATION;    HETEROGENEITY;   

DOI  :  10.1161/01.CIR.100.25.2491

来源: SCIE

【 摘 要 】

Background-Absolute coronary flow velocity reserve (CVR) after stenting may remain abnormal as a result of several different mechanisms. Relative CVR (rCVR= CVRtarget/CVRreference) 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 10+/-9% (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 CVRstent less than or equal to 2.0, increased basal coronary flow, rather than attenuated hyperemia, was responsible in large part for the lower CVRstent compared with patients having CVRstent >2.0. In 8 patients with CVRstent <2.0, a normal rCVR supported global microvascular disease, The subgroup of 9 patients with CVRstent <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 CVRstent 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.

【 授权许可】

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