This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Liebergen, R. A. M. Articles by Lie, K. I. Search for Related Content PubMed PubMed Citation Articles by van Liebergen, R. A. M. Articles by Lie, K. I.

CLINICAL STUDIES

Hyperemic coronary flow after optimized intravascular ultrasound-guided balloon angioplasty and stent implantation

^a Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Manuscript received February 1, 1999; revised manuscript received June 18, 1999, accepted August 25, 1999.

Reprint requests and correspondence: Dr. Jan J. Piek, Dept. of Cardiology, B2-108, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands P.O. Box: 22700, 1100 DD, Amsterdam, the Netherlands
j.j.piek{at}amc.uva.nl

OBJECTIVES

This study evaluated the acute physiological gain of adjunctive intravascular ultrasound (IVUS) guided balloon angioplasty and stent implantation.

BACKGROUND

Recent studies indicate safe coronary luminal enlargement and "stent-like" long-term outcomes using upsized balloons guided by IVUS.

METHODS

After angiographically guided balloon angioplasty in 20 patients with 1-vessel disease and normal left ventricular function, IVUS was performed to determine the size of the adjunctive balloon using the mean of the maximal luminal diameter and the maximal diameter of the external elastic membrane measured in the adjacent proximal and distal reference segments. Serial adenosine-induced hyperemic blood flow velocity measurements were performed using a 0.014'' Doppler guide wire to determine the physiological lumen obstruction after standard balloon angioplasty, followed by IVUS-guided balloon angioplasty and stent implantation.

RESULTS

Upsized balloon angioplasty (increase balloon size: 0.98 ± 0.26 mm; balloon:artery ratio 1.35 ± 0.21) resulted in an additional increase of arterial dimensions: minimal lumen diameter (MLD) 2.18 ± 0.38 mm to 2.73 ± 0.51 mm; percent diameter stenosis (%DS) 34 ± 13% to 19 ± 22%; IVUS assessed minimal lumen area (MLA) 7.53 ± 1.55 mm² to 10.24 ± 2.22 mm² (all p < 0.0001). Major dissections ( type C) did not occur. Hyperemic blood flow velocity increased from 49.8 ± 20.1 cm/s to 59.1 ± 22.9 cm/s (p < 0.05) after IVUS-guided balloon angioplasty. Adjunctive stent implantation resulted in a further increase of MLD to 3.84 ± 0.51 mm, %DS to –9 ± 21% and MLA to 13.39 ± 1.80 mm² (all p < 0.0001), while hyperemic blood flow velocity remained unchanged (61.2 ± 24.7 cm/s, p = 0.7).

CONCLUSIONS

Upsized IVUS-guided balloon angioplasty increases arterial coronary dimensions and the distal hyperemic blood flow velocity. Adjunctive stent implantation does not yield a further gain in the hyperemic blood flow velocity, indicating the absence of a functional residual lumen obstruction after IVUS-guided balloon angioplasty. This may explain a similar clinical outcome reported after those coronary interventions.

Abbreviations and Acronyms   ANOVA = analysis of variance   %AS = percent area stenosis   CFVR = distal coronary flow velocity reserve   CLOUT = Clinical Outcomes with Ultrasound Trial   DEBATE = Doppler End points Balloon Angioplasty Trial Europe   %DS = percent diameter stenosis   IVUS = intravascular ultrasound   MLA = minimal lumen area   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   QCA = quantitative coronary angiography   rCFVR = relative coronary flow velocity reserve

This article has been cited by other articles:

				P. Voci, F. Pizzuto, and F. Romeo Coronary flow: a new asset for the echo lab? Eur. Heart J., November 1, 2004; 25(21): 1867 - 1879. [Full Text] [PDF]

				F. Schiele, N. Meneveau, M. Gilard, J. Boschat, P. Commeau, L. P. Ming, P. Sewoke, M.-F. Seronde, M. Mercier, S. Gupta, et al. Intravascular Ultrasound-Guided Balloon Angioplasty Compared With Stent: Immediate and 6-Month Results of the Multicenter, Randomized Balloon Equivalent to Stent Study (BEST) Circulation, February 4, 2003; 107(4): 545 - 551. [Abstract] [Full Text] [PDF]

				M. Albertal, E. Regar, G. Van Langenhove, S.G. Carlier, J.J. Piek, B. de Bruyne, C. di Mario, D. Foley, K. Kozuma, M.A. Costa, et al. Value of coronary stenotic flow velocity acceleration in prediction of angiographic restenosis following balloon angioplasty Eur. Heart J., December 1, 2002; 23(23): 1849 - 1853. [Abstract] [Full Text] [PDF]

				T. Nishida, C. Di Mario, M.J. Kern, T.J. Anderson, I. Moussa, R. Bonan, T. Muramatsu, A.C. Jain, J. Suarez de Lezo, S.Y. Cho, et al. Impact of final coronary flow velocity reserve on late outcome following stent implantation Eur. Heart J., February 2, 2002; 23(4): 331 - 340. [Abstract] [Full Text] [PDF]

				G. S. Werner, M. Ferrari, B. M. Richartz, O. Gastmann, and H. R. Figulla Microvascular Dysfunction in Chronic Total Coronary Occlusions Circulation, September 4, 2001; 104(10): 1129 - 1134. [Abstract] [Full Text] [PDF]

				F. Pizzuto, P. Voci, E. Mariano, P. Emilio Puddu, G. Sardella, and A. Nigri Assessment of flow velocity reserve by transthoracic Doppler echocardiography and venous adenosine infusion before and after left anterior descending coronary artery stenting J. Am. Coll. Cardiol., July 1, 2001; 38(1): 155 - 162. [Abstract] [Full Text] [PDF]

				A. Colombo and C. Briguori Optimal balloon angioplasty versus elective stent implantation J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1907 - 1909. [Full Text] [PDF]