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Influence of guiding catheter selection on the measurement of coronary flow reserve
A Abizaid1, R Kornowski, G S Mintz
1Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, DC, USA.
Insights
Guiding catheter choice affects coronary flow reserve (CFR) measurements. Catheters with side holes require higher adenosine doses for accurate CFR assessment compared to those without side holes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hemodynamics
Background:
- Accurate measurement of coronary flow reserve (CFR) is crucial for diagnosing and managing coronary artery disease.
- Guiding catheters are essential tools in coronary interventions, but their design may influence hemodynamic measurements.
- The impact of guiding catheter characteristics, specifically the presence or absence of side holes, on CFR assessment is not fully understood.
Purpose of the Study:
- To evaluate how the selection of guiding catheters with or without side holes impacts the measurement of coronary flow reserve (CFR).
- To determine the effect of different guiding catheter designs on the required adenosine dosage for achieving a consistent CFR response.
Main Methods:
- Coronary flow reserve was assessed in a study involving the injection of increasing doses of adenosine.
- Adenosine was administered through three distinct guiding catheters commonly employed in coronary interventions.
- Measurements were compared between guiding catheters featuring side holes and those lacking them.
Main Results:
- Guiding catheters with side holes necessitated approximately double the adenosine dose to elicit a CFR response comparable to that achieved with catheters without side holes.
- A 12-micrograms dose of adenosine through non-side-hole catheters produced a similar CFR response to higher doses in catheters with side holes.
Conclusions:
- Guiding catheter design, particularly the presence of side holes, significantly influences adenosine-dose-dependent CFR measurements.
- Clinicians should consider the type of guiding catheter used when interpreting CFR values, as it affects the necessary pharmacologic stimulus.
- Standardization of guiding catheter selection or adjustment of adenosine dosing protocols may be necessary for reliable CFR assessment in interventional cardiology.
Abstract:
The impact of guiding catheter selection on the measurement of coronary flow reserve was assessed by injecting increasing doses of adenosine through 3 different catheters often used during coronary interventions. When guiding catheters with side holes were used, an approximate doubling of the adenosine dose was required to produce a coronary flow reserve response similar to a 12-micrograms dose of adenosine injected through guiding catheters without side holes.