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Pressure Measurements across Vascular Stenoses. Practice and Pitfalls
1Department of Radiology, Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania, USA.
Summary
Using different catheter sizes in a carotid bulb replica, larger catheters artifactually lowered internal carotid artery pressure and flow across stenoses. This suggests large catheters may inaccurately measure stenosis severity in patients.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Medical Device Analysis
Background:
- Vascular stenoses, particularly in the carotid artery, pose significant risks for stroke.
- Accurate pressure gradient measurements are crucial for assessing stenosis severity.
- Catheter size can potentially influence hemodynamic measurements within stenotic lesions.
Purpose of the Study:
- To analyze the impact of different catheter diameters on pressure measurements across an atherosclerotic human carotid bulb replica.
- To investigate how catheter insertion affects internal carotid artery flow volumes in the presence of stenosis.
- To determine if larger catheters introduce artifacts in transstenotic pressure gradient measurements.
Main Methods:
- Created a human carotid bulb replica with a 58% diameter stenosis using the lost wax technique.
- Utilized a pulsating non-Newtonian fluid circuit to simulate human physiologic flow profiles (600 ml/min).
- Employed 7 French, 5 French, and 2.5 French catheters for pressure and flow measurements within the replica.
Main Results:
- Common carotid artery pressure measurements were unaffected by catheter diameter.
- Internal carotid artery pressures matched control values only with the 2.5 French catheter.
- Larger catheters (7F, 5F) led to decreased internal carotid artery pressures and flow volumes compared to controls.
Conclusions:
- Large diameter catheters can create an occlusive or near-occlusive effect in stenotic vessels.
- This effect artifactually increases measured transstenotic pressure gradients and decreases forward flow.
- Careful consideration of catheter size is essential for accurate hemodynamic assessment of carotid artery stenosis.
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