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Early changes in coronary flow physiology after balloon angioplasty or stenting: a 24-hour Doppler flow velocity
Patrick Dupouy1, Eduardo Aptecar, Gabriel Pelle
1PCVI 77, Clinique les Fontaines, Melun, France. pdupouy@club-internet.fr
Insights
Coronary angioplasty without stenting showed higher stenosis and lower coronary velocity reserve (CVR) initially. However, CVR normalized within 24 hours, influenced by average peak velocity (APV) and myocardial distal resistances.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Physiology
Background:
- Assessing early microcirculatory changes post-coronary angioplasty is crucial.
- Distinguishing effects of balloon angioplasty versus stenting on coronary flow is important.
Purpose of the Study:
- To evaluate early changes in myocardial microcirculation after coronary angioplasty.
- To compare the impact of stenting versus balloon angioplasty on coronary flow velocity and reserve.
Main Methods:
- Studied 57 patients undergoing coronary angioplasty using a Doppler-tipped guidewire.
- Measured quantitative coronary angiography and coronary flow velocity at 10 minutes and 24 hours post-procedure.
- Compared outcomes between patients with and without stenting.
Main Results:
- Unstented group had higher stenosis and lower coronary velocity reserve (CVR) and relative CVR compared to the stented group.
- At 24 hours, CVR and relative CVR normalized in the unstented group, primarily due to decreased basal average peak velocity (APV).
- A negative linear relationship was observed between CVR and APV variations over 24 hours.
Conclusions:
- Coronary reserve can normalize within 24 hours post-angioplasty.
- Post-angioplasty average peak velocity (APV) significantly influences coronary reserve normalization.
- Myocardial distal resistances are key factors in interpreting post-angioplasty CVR.
Abstract:
To evaluate early changes in myocardial microcirculation after balloon or stent coronary angioplasty, we studied 57 patients undergoing coronary angioplasty with a Doppler-tipped guidewire, with (n = 26) or without stenting. Postprocedural quantitative coronary angiography and coronary flow velocity were measured after 10 min and 24 hr. As compared to stenting, no stenting was associated with a higher postprocedural stenosis rate (21% +/- 13% vs. 12% +/- 10%; P < 0.05), smaller coronary velocity reserve (CVR; 2.2 +/- 0.4 vs. 2.5 +/- 0.7; P = 0.04), and smaller relative CVR (0.8 +/- 0.2 vs. 1.1 +/- 0.3; P = 0.001). At 24 hr, CVR and relative CVR in the unstented group increased to the level in the stented group, mainly because of a decrease in basal average peak velocity (APV). Overall, there was a significant negative linear relation between CVR and APV variations during the 24-hr period. In the subgroups with persistent abnormalities, CVR variation was closely related to the basal APV/reference APV ratio. In conclusion, coronary reserve normalization can occur within 24 hr after coronary angioplasty and is closely dependent on postangioplasty APV. Myocardial distal resistances should be considered when interpreting postangioplasty CVR.