Improvement of coronary morphology and blood flow after stenting

Assessment by intravascular ultrasound and intracoronary Doppler
  • Junbo Ge
  • Raimund Erbel
  • Jose Zamorano
  • Michael Haude
  • Peter Kearney
  • Günter Görge
  • Jürgen Meyer
Articles

Abstract

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.

Key words

intravascular ultrasound intracoronary Doppler stenting PTCA 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ellis SG, Roubin GS, King SB, Douglas JS, Shaw RE, Stertzer SH, Myler RK. In-hospital mortality after acute closure after coronary angioplasty: Analysis of risk factors from 8207 procedures. J Am Coll Cardiol 1988; 11: 211–6.Google Scholar
  2. 2.
    Matthews BJ, Ewels CJ, Kent KM. Coronary dissection: Predictor of restenosis? Am Heart J 1988; 115: 547–54.Google Scholar
  3. 3.
    Sigwart U, Peul J, Mikovitch V, Jofre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Eng J Med 1987; 316: 701–6.Google Scholar
  4. 4.
    De Feyter PJ, DeScheerder I, van den Brand M, Laarman GJ, Suryapranata H, Serruys PW. Emergency stenting for refractory acute coronary artery occlusion during coronary angioplasty. Am J Cardiol 1990; 66: 1147–50.Google Scholar
  5. 5.
    Erbel R, Schatz R, Dietz U, Nixdorff U, Haude M, Aichinger S, Pop T, Meyer J. Percutaneous transluminal coronary stent implantation. Z Kardiol 1989; 78: 71–7.Google Scholar
  6. 6.
    Haude M, Erbel R, Straub U, Dietz U, Schatz R, Meyer J. Results of intracoronary dissection after balloon angioplasty. Am J Cardiol 1991; 67: 691–6.Google Scholar
  7. 7.
    Nissen SE, Grines CL, Gurley JC, Sublett K, Haynie D, Diaz C, Booth DC, DeMaria AN. Application of a new phasedarray ultrasound imaging catheter in the assessment of vascular dimensions: In vivo comparison to cineangiography. Circulation 1990; 81: 660–6.Google Scholar
  8. 8.
    Davidson CJ, Sheikh KH, Harrison JK, Himmelstein SI, Leithe ME, Kisslo KB, Bashore TM. Intravascular ultrasonography versus digital subtraction angiography: A human in vivo comparison of vessel size and morphology. J Am Coll Cardiol 1990; 16: 633–6.Google Scholar
  9. 9.
    Ge J, Erbel R, Seidel I, Gorge G, Reichert T, Gerber T, Meyer J. Experimental evaluation of accuracy and safety of intraluminal ultrasound. Z Kardiol 1991; 80: 595–601.Google Scholar
  10. 10.
    Siegel RJ, Chae JS, Forrester JS, Ruiz CE. Angiography, angioscopy, and ultrasound imaging before and after percutaneous balloon angioplasty. Am Heart J 1990; 120: 1086–90.Google Scholar
  11. 11.
    Isner JM, Rosenfield K, Kelly S, Losordo DW, Dejesus ST, Palefsky P, Langevin RE, Razvi S, Pastore JO, Kosowsky BD. Percutaneous intravascular ultrasound examination as an adjunct to catheter-based interventions: Preliminary experience in patients with peripheral vascular disease. Radiology 1990; 175: 61–70.Google Scholar
  12. 12.
    Wilson RF, Laughlin DE, Ackell PH, Chilian WM, Holida MD, Hartley CJ, Armstrong ML, Marcus ML, White CW. Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation 1985; 72: 82–92.Google Scholar
  13. 13.
    Gerber T, Erbel R, Görge G, Ge J, Rupprecht HJ, Meyer J. A classification of morphologic effects of coronary balloon angioplasty assessed by intravascular ultrasound. Am J Cardiol 1992; 70: 1546–54.Google Scholar
  14. 14.
    Schatz RA. A view of vascular stent. Circulation 1989; 79: 445–457.Google Scholar
  15. 15.
    Popma JJ, Dehmer GJ, Eichhorn EJ. Variability of coronary flow reserve obtained immediately after coronary angioplasty. Int J Card Imaging 1991; 6: 31–8.Google Scholar
  16. 16.
    Zijlstra F, Reiber JC, Juilliere Y, Serruys PW. Normalization of coronary flow reserve by percutaneous transluminal coronary angioplasty; Am J Cardiol 1988; 61: 55–60.Google Scholar
  17. 17.
    O'Neill WW, Walton JA, Bates ER, Colfer HT, Aueron FM, LeFree Mt, Pitt B, Vogel RA. Criteria for successful angioplasty coronary angioplasty as assessed by alterations in coronary vaspdilatory reserve. J Am Coll Cardiol 1984; 31: 382–90.Google Scholar
  18. 18.
    Laarman GJ, Serruys PW, Suryapranata H, Brand MVD, Jonkers PR, de Feyter PJ, Roelandt JRTC. Inability of coronary blood flow measurements to assess the efficacy of coronary angioplasty in the first 24 hours in unselected patients. Am Heart J 1991; 122: 631–9.Google Scholar
  19. 19.
    Waller BF. Pathology of coronary balloon angioplasty and related topics. In: Topol EJ, (ed). Textbook of interventional cardiology. Philadelphia: W.B. Saunders Company, 1990: 395–451.Google Scholar
  20. 20.
    Segal J, Kern MJ, Scott NA, King III SB, Doucette JW, Heuser RR, Ofili E, Siegel R. Alterations of phasic coronary artery flow velocity in humans during percutaneous coronary angioplasty. J Am Coll Cardiol 1992; 20: 276–86.Google Scholar
  21. 21.
    Kern MJ, Donohue TJ, Aguirre FV, Bach RG, Caracciolo EA, Ofilli E, Labovitz AJ. Assessment of angiographically intermediate coronary artery stenosis using the Doppler wire. Am J Cardiol 1993; 71: 26D-33D.Google Scholar
  22. 22.
    Ofili EO, Labovitz AJ, Kern MJ. Coronary flow velocity dynamics in normal and diseased arteries. Am J Cardiol 1993; 71: 3D-9D.Google Scholar
  23. 23.
    Di Mario C, Meneveau N, Robert G, de Jaegere P, de Feyter PJ, Slager CJ, Roelandt JRTC, Serruys PW. Maximal blood flow velocity in severe coronary stenoses measured with a Doppler guidewire. Am J Cardiol 1993; 71: 54D-61D.Google Scholar
  24. 24.
    Yamagishi M, Hotta D, Tamai J, Nakatani S, Miyatake K. Validility of catheter-tip Doppler technique in assessment of coronary flow velocity and application of spectrum analysis method. Am J Cardiol 1991; 67: 758–62.Google Scholar
  25. 25.
    Kajiya F, Ogasawora Y, Nakai M, Goto M, Wada Y, Tadoka S, Matsuoka S, Mito K, Fuwruora T. Evaluation of human coronary blood flow with an 80 channel 20 MHz pulsed Doppler velocimeterand zero-cross and Fourier transform methods during cardiac surgery. Circulation 1986; 74: III-53.Google Scholar
  26. 26.
    Tadaoka S, Kagiyama M, Hiramatsu O. Accuracy of 20 MHz Doppler catheter coronary artery velocimetry for measurement of coronary blood flow velocity. Cathet Cardio vasc Diagn 1990; 19: 205–13.Google Scholar
  27. 27.
    Wilson RF, Wyche K, Christensen BV, Laxson DD. Effects of adenosine on human coronary arterial circulation. Circulation 1990; 82: 1595–1606.Google Scholar
  28. 28.
    Golino P, Piscione F, Willerson JT, Cappelli-Bigzzi M, Facaccio A, Villari B, Condorelli M, Chiariello M. Divergent effects of serotonin on coronary artery dimensions and blood flow in patients with coronary atherosclerosis and control patients. N Engl J Med 1991; 324: 641–8.Google Scholar
  29. 29.
    Zeiher Am, Drexler H, Wollschläger H, Just H. Endothelial dysfunction of the coronary microvasculature is associated with impaired coronary flow regulation in patients with early atherosclerosis. Circulation 1991; 84: 1984–92.Google Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • Junbo Ge
    • 1
  • Raimund Erbel
    • 1
  • Jose Zamorano
    • 1
  • Michael Haude
    • 1
  • Peter Kearney
    • 2
    • 1
  • Günter Görge
    • 1
  • Jürgen Meyer
    • 2
    • 1
  1. 1.Department of CardiologyUniversity EssenEssenGermany
  2. 2.II Medical ClinicUniversity MainzGermany

Personalised recommendations