[Normalization of myocardial perfusion reserve after coronary stent implantation in comparison with balloon angioplasty alone].
Stents scaffold coronary arteries after angioplastic treatment and inhibit elastic recoil resulting in a larger and more circular focal lumen. In 25 patients with significant stenoses of the left anterior descending coronary artery, presenting no collaterals or myocardial infarction, EKG-gated digital subtraction angiograms were recorded at baseline and during hyperemia induced by intracoronary injection of 12 mg papaverine before and after balloon angioplasty, and after adjunct implantation of a single Palmaz-Schatz stent. Densitometric evaluation revealed the time parameters contrast medium appearance time (MCAT) rise time (RT) and mean transit time (MTT) and maximum intensity (Imax). Myocardial perfusion reserve (MPR1) was calculated as the ratio of baseline MCAT and hyperemic MCAT multiplied by the ratio of hyperemic Imax and baseline Imax while MPR2 was calculated as the ratio of baseline RT and hyperemic RT. Maximum flow ratio (MaxFR) was calculated as the ratio of preprocedural hyperemic MTT and postprocedural hyperemic MTT. Post-stenotic MPR1 increased from 1.36 +/- 0.28 to 2.50 +/- 1.20 and to 3.40 +/- 0.58 (ANOVA p < 0.05), while reference MPR1 remained unchanged with 3.40 +/- 0.60. Post-stenotic MPR2 increased from 1.57 +/- 0.14 to 2.59 +/- 0.86 after balloon angioplasty and to 3.10 +/- 0.41 after stenting (ANOVA p < 0.05), while reference MPR2 remained unchanged with 3.10 +/- 0.40. MaxFR was 2.13 +/- 0.53 after balloon angioplasty and 2.83 +/- 0.35 after stenting (p < 0.05). A good correlation was found between minimal stenosis diameter and MPR1 or MPR2 (MPR1: r = 0.94; MPR2: r = 0.87) and between luminal gain and MaxFR (r = 0.75). A negative correlation was measured between recoil, defined as the difference between inflated balloon diameter and resulting minimal stenosis diameter, and MPR1 and MPR2 and MaxFR (MPR1: r = -0.86; MPR2 r = -0.80; MaxFR r = -0.83). In conclusion, adjunct coronary stent implantation normalized post-stenotic myocardial perfusion immediately in contrast to balloon angioplasty alone resulting from a larger postprocedural lumen and a more pronounced inhibition of elastic recoil.
Haude
M
M
Abteilung für Kardiologie, Universitätsklinik Essen.
Caspari
G
G
Baumgart
D
D
Eick
B
B
Liu
F
F
Brennecke
R
R
Meyer
J
J
Erbel
R
R
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D015607:Stents; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology
Normalisierung der myokardialen Perfusionsreserve nach koronarer Stentimplantation im Gegensatz zur alleinigen Ballonangioplastie.