Advertisement

Intracoronary blood flow velocity, reactive hyperemia and coronary blood flow reserve during and following PTCA

  • Patrick W. Serruys
  • Felix Zijlstra
  • Hans H. C. Reiber
  • Kevin Beatt
  • G. J. Laarman
  • Jos Roelandt
  • P. J. De Feyter
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 101)

Abstract

Since the introduction of percutaneous transluminal coronary angioplasty (PTCA) in 1977 [1], the procedure has gained increasing importance in the treatment of coronary artery obstructions. So far, the immediate results of the procedure have been assessed by coronary angiography and the residual pressure gradient. However, the change in luminal size of an artery following the mechanical disruption of its internal wall cannot be assessed accurately from the detected angiographic contours [2, 3]. The measured residual pressure gradient may have short and long-term prognostic value, but it reflects only the hemodynamic state at rest [4, 5, 6]. Recently the assessment of coronary flow reserve has been proposed as a better method to evaluate the functional results of dilatation of a coronary artery obstruction [7, 8, 9, 10]. Papaverine is currently regarded as the vasodilator of choice for the induction of maximal hyperemia, as intracoronary administration results in an immediate, potent and short-lasting hyperemia [11, 12]. Intracoronary blood flow velocity measurements with a Doppler probe, and the radiographic assessment of myocardial perfusion with contrast media have previously been used to investigate regional coronary flow reserve [13–17]. In the present study we compared both techniques in the setting of PTCA, and compared the pharmacologically induced vasodilation after intracoronary papaverine with reactive hyperemia following transluminal occlusion.

Keywords

Blood Flow Velocity Coronary Flow Reserve Coronary Blood Flow Reactive Hyperemia Doppler Probe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Grüntzig AR, Senning A, Siegenthaler WE (1979) Nonoperative dilatation of coronary artery stenosis: percutaneous transluminal angioplasty. N Engl J Med 301: 61 - 8PubMedCrossRefGoogle Scholar
  2. 2.
    Block PC, Myler RK, Stertzer S, Fallon JT (1981) Morphology after transluminal angioplasty in human beings. N Engl J Med 305: 382 - 5PubMedCrossRefGoogle Scholar
  3. 3.
    Serruys PW, Reiber JHC, Wijns W, van den Brand M, Kooyman CJ, ten Katen HJ, Hugenholtz PG (1984) Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: Diameter versus densitometric area measurements. Am J Cardiol 54: 482–488PubMedCrossRefGoogle Scholar
  4. 4.
    Leimgruber PP, Roubin GS, Hollman J, Cotsonis GA, Meier B, Douglas JS, King SB, Gruentzig AR (1986) Restenosis after successful coronary angioplasty in patients with single-vessel disease. Circulation 73: 710 - 717PubMedCrossRefGoogle Scholar
  5. 5.
    Serruys PW, Wijns W, Reiber JHC, de Feyter P, van den Brand M, Piscione F, Hugenholtz PG (1985) Values and limitations of transstenotic pressure gradients measured during percutaneous coronary angioplasty. Herz 6: 337 - 342Google Scholar
  6. 6.
    Redd DCB, Roubin GS, Leimgruber PP, Abi-Mansour P, Douglas JS, King SB (1987) The transstenotic pressure gradient trend as a predictor of acute complications after percutaneous transluminal coronary angioplasty. Circulation 76: 792 - 801PubMedCrossRefGoogle Scholar
  7. 7.
    Hoffman JIE (1984) Maximal coronary flow and the concept of vascular reserve. Circulation 70: 153 - 159PubMedCrossRefGoogle Scholar
  8. 8.
    Klocke FJ (1983) Measurements of coronary blood flow and degree of stenosis: current clinical implications and continuing uncertainties. J Am Coll Cardiol 1: 31 - 41PubMedCrossRefGoogle Scholar
  9. 9.
    Serruys PW, Juilliere Y, Zijlstra F, Beatt KJ, de Feyter PJ, Suryapranata H, vd Brand M, Roelandt J (1988) Coronary Blood Flow velocity during PTCA: a guide-line for assessment of functional results. Am J Cardiol 61: 253 - 259Google Scholar
  10. 10.
    Zijlstra F, Reiber JC, Juilliere Y, Serruys PW (1988) Normalization of coronary flow reserve by percutaneous transluminal coronary angioplasty. Am J Cardiol 61: 55 - 60PubMedCrossRefGoogle Scholar
  11. 11.
    Wilson RF, White CW (1986) Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans. Circulation 73: 444 - 451PubMedCrossRefGoogle Scholar
  12. 12.
    Zijlstra F, Serruys PW, Hugenholtz PG (1986) Papaverine: The ideal coronary vasodilator for investigating coronary flow reserve. A study of timing, magnitude, reproducibility and safety of the coronary hyperemic response after intracoronary papaverine. Cath Cardiovasc Diagn 12: 298–303CrossRefGoogle Scholar
  13. 13.
    Wilson RF, Laughlin DE, Ackell PH, Chilian WM, Holida MD, Hartley CJ, Armstrong ML, Marcus ML, White CW (1985) Transluminal subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation 72: 82 - 92PubMedCrossRefGoogle Scholar
  14. 14.
    Bates ER, Aueron FM, Le Grand V, Le Free MT, Mancini GBJ, Hodgson JM, Vogel RA (1985) Comparative long-term effects of coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty on regional coronary flow reserve. Circulation 72: 833 - 839PubMedCrossRefGoogle Scholar
  15. 15.
    Zijlstra F, van Ommeren J, Reiber JHC, Serruys PW (1987) Does quantitative assessment of coronary artery dimensions predict the physiological significance of a coronary stenosis? Circulation 75: 1154 - 1161PubMedCrossRefGoogle Scholar
  16. 16.
    Vogel RA (1985) The radiographic assessment of coronary blood flow parameters. Circulation 72: 460 - 465PubMedCrossRefGoogle Scholar
  17. 17.
    Sibley DH, Millar HD, Hartley CJ, Whitlow PL (1986) Subselective measurement of coronary blood flow velocity using a steerable Doppler catheter. JACC 8: 1332 - 1340PubMedGoogle Scholar
  18. 18.
    Marcus ML (1983) Physiological effects of a coronary stenosis, pp. 242-269 in: The Coronary Circulation in Health and Disease. New York: McGraw-HillGoogle Scholar
  19. 19.
    Marcus ML (1983) Effects of cardiac hypertrophy on the coronary circulation, pp. 285-306 in: The Coronary Circulation in Health and Disease. New York: McGraw-HillGoogle Scholar
  20. 20.
    Marcus ML, Doty DB, Hiratzka LP, Whight CB, Eastham CL (1985) Decrease coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 307: 1362 - 1366CrossRefGoogle Scholar
  21. 21.
    Cole JS, Hartley CJ (1977) The pulsed Doppler coronary artery catheter. Preliminary report of a new technique for measuring rapid changes in coronary artery flow velocity in man. Circulation 56: 18–25PubMedGoogle Scholar
  22. 22.
    Hartley CJ, Cole JS (1974) An ultrasonic pulsed Doppler system for measuring blood flow in small vessels. J Appl Physiol 37: 626 - 629PubMedGoogle Scholar
  23. 23.
    Wilson RF, Laughlin DE, Ackell PH, Chilean WM, Holida MD, Hartley CJ, Armstrong ML, Marcus ML, White CW (1985) Transluminal subelective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation 72: 82 - 92PubMedCrossRefGoogle Scholar
  24. 24.
    Reiber JHC, Serruys PW, Kooyman CJ, Wijns W, Slager CJ, Gerbrand JJ, Schuurbiers JCH, den Boer A, Hugenholtz PG (1985) Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantification of coronary cineangiograms. Circulation 71: 280 - 288PubMedCrossRefGoogle Scholar
  25. 25.
    Reiber JHC, Kooijman CJ, Slager CJ, Gerbrands JJ, Schuurbiers JHC, den Boer A, Wijns W, Serruys PW, Hugenholtz PG (1984) Coronary artery dimensions from cineangiograms; methodology and vasodilation of a computer-assisted analysis procedure. IEEE Trans Med Imaging MI-3: 131 - 141Google Scholar
  26. 26.
    Reiber JHC, Kooijaman CJ, den Boer A, Serruys PW (1985) Assessment of dimensions and image quality of coronary contrast catheters from cineangiograms. Cath Cardiovasc Diagn 11: 521 - 531CrossRefGoogle Scholar
  27. 27.
    Zijlstra F, Reiber JHC, Serruys PW (1988) Does intracoronary papaverine dilate epicardial coronary arteries? Implications for the assessment of coronary flow reserve. Cath Cardiovasc Diagn 14: 1 - 6CrossRefGoogle Scholar
  28. 28.
    van der Werf T, Heethaar RM, Stegehuis H, Meyler FL (1984) The concept of apparent cardiac arrest as a prerequisite for coronary digital subtraction angiography. J Am Coll Cardiol 4: 239 - 244PubMedCrossRefGoogle Scholar
  29. 29.
    Rentrop KP, Cohen M, Blanke H, Philips RA (1985) Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 5: 587 - 592PubMedCrossRefGoogle Scholar
  30. 30.
    Kajiva F, Ogasawara Y, Tsuyioka K, Nakai M, Coto M, Wada Y, Tadaoka S, Matsuoka S, Mito K, Fuwruara T (1986) Evaluation of human coronary blood flow with an 80 channel transform methods during cardiac surgery. Circulation 74 (suppl III): 53 - 60Google Scholar
  31. 31.
    Sibley D, Bulle T, Baxley W, Dean L, Whitlow P (1986) Continuous on-line assessment of coronary angioplasty with a Doppler tipped balloon dilatation catheter (abstr). Circulation 74 (Suppl II): 459Google Scholar
  32. 32.
    Marcus M, Wright C, Doty D, Eastham C, Laughlin D, Krumm P, Fastenow C, Brody M (1981) Measurements of coronary velocity and reactive hyperemia in the coronary circulation of humans. Circ Res 49: 877 - 897PubMedGoogle Scholar
  33. 33.
    Mc Pherson DD, Hiratzka LF, Lamberth WC, Brandt B, Hunt M, Kieso RA, Marcus ML, Kerber RF (1987) Delineation of the extent of coronary atherosclerosis by high-frequency epicardial echocardiography. N Engl Med 316: 304 - 309CrossRefGoogle Scholar
  34. 34.
    Kilpatrick D, Webber SB (1986) Intravascular blood velocity in simulated coronary artery stenoses. Cath Cardiovasc Diagn 12: 317 - 313CrossRefGoogle Scholar
  35. 35.
    Wangler RD, Peters KG, Laughlin DE, Tomanek RJ, Marcus ML (1981) A method for continuously assessing coronary velocity in the rat. Am J Physiol 10: H816 - 820Google Scholar
  36. 36.
    Marcus ML, Wilson RF, White CW (1987) Methods of measurements of myocardial blood flow in patients: a critical review. Circulation 76: 245 - 253PubMedCrossRefGoogle Scholar
  37. 37.
    Hodgson JM, Mancini GBJ, LeGrand V, Vogel RA (1985) Characterization of changes in coronary blood flow during the first six seconds after intracoronary contrast injection. Invest Radiol 20: 246 - 252PubMedCrossRefGoogle Scholar
  38. 38.
    Hodgson JM, LeGrand V, Bates ER, Mancini GBJ, Aueron FM, O’Neill WW, Simon SB, Beauman GJ, LeFree MT, Vogel RA (1985) Validation in dogs of a rapid angiographic technique to measure relative coronary blood flow during routine cardiac catheterization. Am J Cardiol 55: 188 - 193PubMedCrossRefGoogle Scholar
  39. 39.
    Klocke FJ (1987) Measurements of coronary flow reserve: Defining pathophysiology versus making decisions about patient care. Circulation 76: 1183 - 1189PubMedCrossRefGoogle Scholar
  40. 40.
    Bookstein J J, Higgins CB (1977) Comparative efficacy of coronary vasodilatory methods. Investigate Radiology 12: 121 - 127CrossRefGoogle Scholar
  41. 41.
    Wilson RF, Marcus ML, White CW (1987) Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. Circulation 75: 723 - 732PubMedCrossRefGoogle Scholar
  42. 42.
    Hodgson JM, Riley RS, Most AS, Williams DO (1987) Assessment of coronary flow reserve using digital angiography before and after successful percutaneous transluminal coronary angioplasty. Am J Cardiol 60: 61 - 65PubMedCrossRefGoogle Scholar
  43. 43.
    Bates ER, Mc Gillem MJ, Beats TF, DeBoe SF, Mickelson JK, Mancini GBJ, Vogel RA (1987) Effect of angioplasty induced endothelial denudation compared with medial injury on regional coronary blood flow. Circulation 76: 710 - 716PubMedCrossRefGoogle Scholar
  44. 44.
    Serruys PW, Wijns W, van den Brand M, Mey S, Slager C, Schuurbiers JCH, Hugenholtz PG, Brower RW (1984) Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation 70: 25 - 36PubMedCrossRefGoogle Scholar
  45. 45.
    Feldman RL, Conti R, Pepine CJ (1983) Regional coronary venous flow responses to transient coronary artery occlusion in human beings. J Am Coll Cardiol 2: 1 - 10PubMedCrossRefGoogle Scholar
  46. 46.
    Rothman MT, Baim DS, Simpson JB, Harrison DC (1982) Coronary hemodynamics during percutaneous transluminal coronary angioplasty. Am J Cardiol 49: 1615 - 1622PubMedCrossRefGoogle Scholar
  47. 47.
    Serruys PW, Piscione F, Wijns W, Harmsen E, van den Brand M, de Feyter P, Hugenholtz PG, de Jong JW (1986) Myocardial release of hypoxanthine and lactate during percutaneous transluminal coronary angioplasty: A quickly reversible phenomenon, but for how long? pp 75ff in: Serruys PW, Transluminal coronary angioplasty: An investigational tool and a non-operative treatment of acute myocardial ischemia. (Doctoral Thesis, Erasmus University, Rotterdam, The Netherlands)Google Scholar
  48. 48.
    Webb SC, Rickards AF, Poole-Wilson PA (1983) Coronary sinus potassium concentration recorded during coronary angioplasty. Br Heart J 50: 146 - 152PubMedCrossRefGoogle Scholar
  49. 49.
    Peterson MB, Machay V, Block PC, Palacios I, Philbin D, Watkins WD (1986) Thromboxane release during percutaneous transluminal coronary angioplasty. Am Heart J 1: 111 - 119Google Scholar
  50. 50.
    Wilson RF, Aylward PE, Leimbach WH, Talman CL, White CW (1986) Coronary flow reserve late after PTCA. - Do the early alterations persist? (abstr). J Am Coll Cardiol 7: 212A (suppl)Google Scholar
  51. 51.
    Johnson MR, Brayden GP, Ericksen EE, Collins SM, Skaton DJ, Harrison DG, Marcus ML, White CW (1986) Changes in cross-sectional area of the coronary lumen in the six months after angioplasty: a quantitative analysis of the variable response to percutaneous transluminal angioplasty. Circulation 73: 467 - 475PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers, Dordrecht 1990

Authors and Affiliations

  • Patrick W. Serruys
  • Felix Zijlstra
  • Hans H. C. Reiber
  • Kevin Beatt
  • G. J. Laarman
  • Jos Roelandt
  • P. J. De Feyter

There are no affiliations available

Personalised recommendations