Skip to main content

Measurement of coronary artery pressure and stenosis gradients — clinical applications

  • Chapter
Quantitative Coronary Angiography in Clinical Practice

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 145))

Abstract

When considering a patient with ischemic heart disease for an invasive procedure such as coronary angioplasty (PTCA) or coronary artery bypass surgery (CABG), decision-making is heavily dependent on reliable tools to assess the physiological and clinical importance of the obstruction in the coronary artery. In spite of progressive refinements of computer-assisted analysis of the coronary angiogram during recent years, there are still some inherent limitations of the method that may render assessment of certain stenosis less reliable. In particular, diffuse atherosclerotic involvement, tortuous, long irregular lesions will be more difficult to evaluate. In addition, following PTCA the intimai layer of the vessel wall is frequently damaged, which may affect the angiographic picture considerably giving the appearance of haziness, intimal flaps or widespread dissection. This makes the interpretation of the angiographic picture even more difficult leaving an obvious need for complementary methods with a more physiological approach in these situations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 429.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 549.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 549.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Emanuelsson H, Dohnal M, Lamm C, Tenerz L. Initial experiences with a miniaturized pressure transducer during coronary angioplasty. Cath Cardiovasc Diag 1991; 24: 137–143.

    Article  CAS  Google Scholar 

  2. Doucette JW, Corl DP, Payne HM, Flynn AE, Goto M, Nassi M, Segal J. Validation of a Doppler guide wire for intravascular measurements of coronary artery flow velocity. Circulation 1992; 85: 1899–1911.

    Article  PubMed  CAS  Google Scholar 

  3. Young DF. (1979) Fluid mechanics of arterial stenosis. J Biomech Eng 101: 157–175.

    Article  Google Scholar 

  4. Gould KL, Kelley KO, Bolson EL. Experimental validation of quantitative coronary arteriography for determining pressure-flow characteristics of coronary stenosis. Circulation 1982; 66: 930–937.

    Article  PubMed  CAS  Google Scholar 

  5. Gould KL, Kelley KO. Physiological significance of coronary flow velocity and changing stenosis geometry during coronary vasodilation in awake dogs. Circ Res 1982; 50: 695–704.

    Article  PubMed  CAS  Google Scholar 

  6. Gould KL. Dynamic coronary stenosis. Am J Cardiol 1980; 45: 286–292.

    Article  PubMed  CAS  Google Scholar 

  7. Zijlstra F, Reiber JHC, Serruys PW. Does intracoronary papaverine dilate epicardial coronary arteries? Cath Card Diagn 1988; 14: 1–6.

    Article  CAS  Google Scholar 

  8. Hök B, Tenerz L, Gustafsson K. Fiberoptic sensor–A micromechanical approach. Sensors and Actuators 1989; 17: 157–166.

    Article  Google Scholar 

  9. Tenerz L, Smith L, Hök B. A fiberoptic silicon pressure microsensor for measurements in coronary arteries. Transducer 1991; Cat. no 91 CH 2817–5: 1021–1023.

    Google Scholar 

  10. Reiber JHC, Kooijman CJ, Slager CJ, Gerbrands JJ, Schuurbiers JCH, den Boer A, Wijns W, Serruys PW, Hugenholtz PG. Coronary artery dimensions from cineangiograms: methodology and validation of a computer-assisted analysis procedure. IEEE Trans Med Imaging 1985; MI-3: 131–141.

    Google Scholar 

  11. Di Mario C., Haase J., den Boer A., Reiber JHC., Serruys PW. (1992) Edge detection versus densitometry in the quantitative assessment of stenosis phantoms: an in vivo comparison in porcine coronary arteries. Am Heart J 1992; 124: 1181–1189.

    Article  Google Scholar 

  12. Reiber JHC et al. On-line quantification of coronary angiograms with the DCI system. Medica Mundi 1989; 34: no. 3, 89–98.

    Google Scholar 

  13. Haase J, Di Mario C, Slager CJ, van der Giessen W, den Boer A, de Feyter P, Reiber JHC, Verdouw PD, Serruys PW. In vivo validation of on-line geometric coronary measurements using insertion of stenosis phantoms in porcine coronary arteries. Cathet Cardiovasc Diag 1992; 27: 16–27.

    Article  CAS  Google Scholar 

  14. Leiboff R., Bren G., Katz R., Korkegi R., Ross A. Determinants of transstenotic gradients observed during angioplasty: An experimental model. Am J Card 1983; 52: 1311–1317.

    Article  PubMed  CAS  Google Scholar 

  15. De Bruyne B, Pijls NHJ, Paulus WJ, Vantrimpont PJ, Sys SU, Heyndrickx GR. Transstenotic coronary pressure gradient measurement in man: in vitro and in vivo evaluation of a new pressure monitoring PTCA guide-wire. J. Amer. Coll. of Cardiol 1993; 22: 119–126.

    Article  Google Scholar 

  16. Serruys PW, Wijns W, Reiber JHC, dse Feyter P, van den Brand M, Piscione F, Hugenholtz PG. Values and limitations of transstenotic pressure gradients measured during percutaneous coronary angioplasty. Herz 1985; 10: 337–342.

    PubMed  CAS  Google Scholar 

  17. Gould KL, Lipscomb K, Hamilton GW. Physiological basis for assessing critical coronary stenosis. Am J Cardiol 1984; 33: 87–94.

    Article  Google Scholar 

  18. Hodgson JMcB, Legrand V, Bates ER, Mancini BGJ, Aueron FM, O’Niell WW, Simon SB, Beauman GJ, LeFree MT, Vogel RA. Validation in dogs of a rapid digital angiographic technique to measure relative. coronary blood flow during routine cardiac catheterization. Am J Cardiol 1985; 55: 188–193.

    Google Scholar 

  19. Marcus M, Wright C, Doty D, Eastman C, Laughlin D, Krumm P, Fastenow C, Brody M. Measurement of coronary artery pressure and stenosis gradients 179 Measurements of coronary velocity and reactive hyperemia in the coronary circulation of humans. Circ Res 1981; 49: 877–891.

    Article  PubMed  CAS  Google Scholar 

  20. Klocke FJ. Measurements of coronary flow reserve: Defining pathophysiology vs making decisions about patient care. Circulation 1987; 76: 1183–1198.

    Article  PubMed  CAS  Google Scholar 

  21. Mancini GBJ, McGillem MJ, DeBoe SF, Gallagher KP. The diastolic hyperemic flow versus pressure relation: A new index of coronary stenosis severity and flow reserve. Circulation 1989; 80: 941–950.

    Article  PubMed  CAS  Google Scholar 

  22. Mancini BGJ, Cleary RM, Scott F, DeBoe BS, Moore NB, Gallagher KP. Instantaneous hyperemic flow-versus-pressure slope index. Microsphere validation of an alternative to measures of coronary reserve. Circulation 1991; 84: 862–870.

    Article  PubMed  CAS  Google Scholar 

  23. Gould KL. Pressure-flow characteristics of coronary stenoses in unsedated dogs at rest and during coronary vasodilation. Circ Res 1978; 43: 242–253.

    Article  PubMed  CAS  Google Scholar 

  24. Pijls NHJ, De Bruyne B, Kirkeeide RL, Gould KL. Quantitation of relative coronary flow reserve and collateral flow by pressure measurements during maximal hyperaemia: A rapid, accurate method for assessing functional stenosis severity at PTCA. Circulation 1993; 87: 1345–1367.

    Article  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer Science+Business Media New York or Springer Science+Business Media Dordrechtt

About this chapter

Cite this chapter

Emanuelsson, H., Dohnal, M., Lamm, C., Mario, C.D., Serruys, P.W. (1994). Measurement of coronary artery pressure and stenosis gradients — clinical applications. In: Serruys, P.W., Foley, D.P., De Feyter, P.J. (eds) Quantitative Coronary Angiography in Clinical Practice. Developments in Cardiovascular Medicine, vol 145. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-8358-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-94-015-8358-9_11

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-90-481-4295-8

  • Online ISBN: 978-94-015-8358-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics