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CLINICAL STUDIES

Early recovery of coronary flow reserve after stent implantation as assessed by positron emission tomography

Istvan Kosa, MD^,1, Rudolf Blasini, MD^a, Jan Schneider-Eicke, MD, Timm Dickfeld, MD^a, Franz J. Neumann, MD^a, Sibylle Ziegler, PhD, Ichiro Matsunari, MD, Jodi Neverve, BS, Albert Schömig, MD^a and Markus Schwaiger, MD, FACC

^a Department of Internal Medicine, München, Germany
Department ofNuclear Medicine, Klinikum rechts der Isar, der Technische Universität, München, Germany

Manuscript received October 15, 1996; revised manuscript received March 25, 1999, accepted June 25, 1999.

Reprint requests and correspondence: Dr. Markus Schwaiger, Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität, München, Ismaninger Str. 22, D-81675 München, Germany
tbb03as{at}sunmail.lrz-muenchen.de

OBJECTIVES

The aim of this study was to quantitatively evaluate myocardial flow reserve in patients early after coronary stent implantation using positron emission tomography.

BACKGROUND

Delayed restoration of coronary flow reserve after percutaneous transluminal coronary angioplasty (PTCA) has been observed using a variety of techniques. Altered distal vasoregulation as well as residual stenosis have been considered possible explanations for this phenomenon. Although the implantation of stents may influence some of these mechanisms, little data are available characterizing coronary flow reserve early after stent placement.

METHODS

In 14 patients 1.6 ± 0.6 days after stenting, N-13-ammonia positron emission tomographic studies were performed at rest and during adenosine-induced vasodilation. Myocardial blood flow was quantified using a three-compartment model. Rest and stress flow data, as well as coronary flow reserve of stented vascular territories, were compared with that of remote areas.

RESULTS

The stenosis decreased from 72.1 ± 7.3% to 3.7 ± 6.7% after stent implantation. Coronary flow in the stented areas did not differ significantly from that in remote areas either at rest (76.1 ± 18.5 and 75.7 ± 17.7 ml/min/100 g, respectively), or during maximal vasodilation (205.5 ± 59.9 and 179.4 ± 47.4 ml/min/100 g, respectively). In addition, there was no significant difference in the calculated values of coronary reserve of these two regions (2.74 ± 0.64 and 2.43 ± 0.55, respectively).

CONCLUSIONS

The mechanical support of dilated arteries by a stent not only restores the macroscopic integrity of epicardial arteries, but also results, in contrast to conventional PTCA procedures, in early recovery of flow reserve.

Abbreviations and Acronyms   LAD = left anterior descending artery   LCX = left circumflex artery   PET = Positron emission tomography   PTCA = percutaneous transluminal coronary angioplasty   RCA = right coronary artery

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