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Detection of coronary restenosis aftercoronary angioplasty by contrast-enhanced transthoracic echocardiographic Doppler assessment of coronary flow velocity reserve

Massimo Ruscazio, MD^*,*, Roberta Montisci, MD^*, Paolo Colonna, MD^*, Carlo Caiati, MD^*, Lijun Chen, MD^*, Giorgio Lai, MD^*, Mauro Cadeddu, MD^*, Raimondo Pirisi, MD^* and Sabino Iliceto, MD, FACC

^* Department of Cardiovascular and Neurological Science, University of Cagliari, Italy
Division of Cardiology, Department of Internal Medicine, University of Padua, Italy

View larger version (85K): [in a new window]   Figure 1 Absence of left anterior descending coronary artery (LAD) restenosis after percutaneous transluminal coronary angioplasty (PTCA) at six-month follow-up angiography in Patient no. 8 (see Table 1). Severe LAD stenosis (upper left panel) was successfully treated with PTCA and stent placement (upper middle panel). At the end of follow-up, angiography showed the absence of restenosis (upper right panel). Coronary flow velocity assessed by contrast-enhanced transthoracic echocardiography on the day before angiography increased from baseline (lower left panel) to post-adenosine administration (lower right panel), with a calculated coronary flow reserve of 3.6. The arrows indicate the PTCA site. CX = circumflex artery.

View larger version (90K): [in a new window]   Figure 2 Restenosis in the LAD five months after PTCA in Patient no. 27 (see Table 1). In the upper left panel, tight coronary stenosis (arrow) was successfully treated by PTCA and stent placement (upper middle panel). Coronary angiography performed at five months, before the scheduled end of follow-up, because of angina recurrence, revealed 72% intrastent stenosis of the proximal LAD (upper right panel). Coronary flow velocity assessed by CE-TTE on the day before angiography did not increase from baseline (lower left panel) to post-adenosine administration (lower right panel), showing severe impairment with a calculated CFR value of 1.1. The arrows indicate the PTCA site. See Figure 1 for abbreviations.

View larger version (15K): [in a new window]   Figure 3 Bar graph indicating coronary flow reserve (CFR) values for angiographic studies showing or not showing post-percutaneous transluminal coronary angioplasty restenosis (groups A and B). The mean values ± SD are also shown. LAD = left anterior descending coronary artery.