Instability of reference diameter in the evaluation of stenosis after coronary angioplasty: Percent diameter stenosis overestimates dilative effects due to reference diameter reduction
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Purpose: To examine changes in the reference segment luminal diameter after coronary angioplasty.
Methods: Sixty-one patients with stable angina pectoris or old myocardial infarction were examined. Coronary angiograms were recorded before coronary angioplasty (pre-angioplasty) and immediately after (post-angioplasty), as well as 3 months after. Artery diameters were measured on cine-film using quantitative coronary angiographic analysis.
Results: The diameters of the proximal segment not involved in the balloon inflation and segments in the other artery did not change significantly after angioplasty, but the reference segment diameter significantly decreased (4.7%). More than 10% luminal reduction was observed in seven patients (11 %) and more than 5% reduction was observed in 25 patients (41%). More than 5% underestimation of the stenosis was observed in 22 patients (36%) when the post-angioplasty reference diameter was used as the reference diameter, compared with when the pre-angioplasty measurement was used and more than 10% underestimation was observed in five patients (8%).
Conclusion: This study indicated that evaluation by percent diameter stenosis, with the reference diameter from immediately after angioplasty, overestimates the dilative effects of coronary angioplasty, and that it is thus better to evaluate the efficacy of angioplasty using the absolute diameter in addition to percent luminal stenosis.
Key wordsCoronary angiography Ischemic heart disease Atherosclerosis Luminal diameter Coronary angiogram
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- 1.Detre K, Holubkov R, Kelsey S, Cowley M. Kent K, Williams D, Myler R, Faxon D, Holmes D, Bourassa M, Block P, Gosselin A, Bentivoglio L, Leatherman L, Dorros G, King S. Galichia J, Al-Bassam M, Leon M, Robertson T, Passamani E, and the Coinvestigators of the NHLBI’s PTCA Registry (1988) Percutaneous transluminal coronary angioplasty in 1985–1986 and 1977–1981. The National Heart, Lung, and Blood Institute Registry. N Engl J Med 318:265–270PubMedGoogle Scholar
- 7.Baumgartner HR, Spaet TH (1970) Endothelial replacement in rabbit arteries. Fed Proc 29:710–715Google Scholar
- 9.Strauss BH, Escaned J, Foley DP, di Mario C, Haase J, Keane D, Hermans WRM, ter de Feyter PJ, Serruys PW (1994) Technologic considerations and practical limitations in the use of quantitative angiography during percutaneous coronary recanalization. Prog Cardiovasc Dis 36:343–362PubMedCrossRefGoogle Scholar
- 10.Nissen SE (1993) Radiographic principles in cardiac catheterization. In: Roubin GS, Califf RM O’Neill W. Phillips H, Slack RS (eds) Interventional Cardiac Catheterization: Principles and Practice. Churchill Livingstone, New York, pp 409–425Google Scholar
- 14.Foley DP, Deckers J, van den Bos AA, Heyndrickx GR, Laarman G, Suryapranata H, Zijlstra F, Serruys P (1993) Usefulness of repeat coronary angiography 24 hours after successful balloon angioplasty to evaluate early luminal deterioration and facilitate quantitative analysis. Am J Cardiol 72:1341–1347PubMedCrossRefGoogle Scholar
- 15.Hermans WRM, Foley DP, Rensing BJ, Serruys PW (1994) Morphologic changes during follow-up after successful percutaneous transluminal coronary balloon angioplasty: Quantitative angiographic analysis in 778 lesions—further evidence for the restenosis paradox. Am Heart J 127:483–494PubMedCrossRefGoogle Scholar
- 16.Beatt KJ, Luijten HE, de Feyter PJ, van den Brand M, Reiber JHC, Serruys PW (1988) Changes in diameter of coronary artery segments adjacent to stenosis after percutaneous transluminal coronary angioplasty: Failure of percent diameter stenosis measurement to reflect morphologic changes induced by balloon dilation. J Am Coll Cardiol 12:315–323PubMedGoogle Scholar
- 17.Rensing BJ, Hermans WRM, Deckers JW, de Feyter PJ, Tijssen JGP. Serruys PW (1992) Lumen narrowing after percutaneous transluminal coronary balloon angioplasty follows a near Gaussian distribution: A quantitative angiographic studv in 1,445 successfully dilated lesions. J Am Coll Cardiof 19:939–945CrossRefGoogle Scholar