title: Physiologically guided angioplasty in support to a provisional stenting strategy: immediate and six-month outcome.
abstract: The results of an observational multicenter angioplasty study suggested that stenting decisions may be facilitated by physiologic data. The purpose of this study was to evaluate the early and long-term clinical and angiographic outcome of prospective physiologically guided provisional stenting. Coronary angioplasty using a Doppler-tipped angioplasty guidewire was performed in 68 patients. The provisional stent strategy dictated that balloon angioplasty was to be continued until a coronary flow reserve was >/= 2.2 with a residual diameter stenosis by quantitative coronary angiography < 35%. Repeat coronary angiography was obtained at 6 months. Based on the study criteria, 32/68 patients (47%) received a stent. Compared to the stent group, the angioplasty alone group had higher postprocedural stenosis (23% +/- 13% vs. 13% +/- 10%; P < 0. 05) and lower coronary vasodilatory reserve (2.3 +/- 0.4 vs. 2.6 +/- 0.7; P < 0.05). At follow-up (6.0 +/- 1.5 months), the angiographic restenosis rate was 39% in the angioplasty group and 35% in the stent groups (P = NS). Adverse cardiac events (unstable angina, target lesion revascularization, myocardial infarction, death) occurred in 19% and 18% (P = NS) of the angioplasty and stent patients, respectively. A prospective application of a physiologically guided provisional stent strategy for coronary angioplasty indicated that stent implantation may be required in approximately 50% of patients, an approach that produces similar clinical and angiographic long-term outcomes for stenting and guided angioplasty. These data support a role of coronary physiology as an adjunct in conducting an angioplasty procedure without obligatory stenting.
authors.affiliation: Unité d'Hémodynamique et de Cardiologie Interventionnelle, Service de Physiologie Explorations Fonctionnelles, Fédération de Cardiologie, Hôpital Henri Mondor AP-HP, Créteil, France. patrick.dupouy@hmn.ap-hop-paris.fr
authors.forename: P
authors.initials: P
authors.lastname: Dupouy
authors.forename: G
authors.initials: G
authors.lastname: Pelle
authors.forename: P
authors.initials: P
authors.lastname: Garot
authors.forename: M J
authors.initials: MJ
authors.lastname: Kern
authors.forename: G
authors.initials: G
authors.lastname: Kane
authors.forename: J
authors.initials: J
authors.lastname: Woscoboinick
authors.forename: E
authors.initials: E
authors.lastname: Aptecar
authors.forename: A
authors.initials: A
authors.lastname: Belarbi
authors.forename: J M
authors.initials: JM
authors.lastname: Pernés
authors.forename: J L
authors.initials: JL
authors.lastname: Dubois Randè
authors.forename: E
authors.initials: E
authors.lastname: Teiger
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D019160:Endosonography / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome