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(Circulation. 2005;111:76-82.)
© 2005 American Heart Association, Inc.

Interventional Cardiology

Influence of Percutaneous Coronary Intervention on Coronary Microvascular Resistance Index

Bart-Jan Verhoeff, MD; Maria Siebes, PhD; Martijn Meuwissen, MD; Bekta Atasever, MD; Michiel Voskuil, MD; Robbert J. de Winter, MD; Karel T. Koch, MD; Jan G.P. Tijssen, PhD; Jos A.E. Spaan, PhD; Jan J. Piek, MD

From the Departments of Cardiology (B.-J.V., M.S., M.M., B.A., M.V., R.J.d.W., K.T.K., J.G.P.T., J.J.P.) and Medical Physics (M.S., J.A.E.S.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Correspondence to Maria Siebes, PhD, Department of Medical Physics, Academic Medical Center, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail m.siebes{at}amc.uva.nl

Received May 23, 2004; revision received September 28, 2004; accepted October 1, 2004.

Background— Coronary microvascular resistance during maximal hyperemia is generally assumed to be unaffected by percutaneous coronary interventions (PCIs). We assessed a velocity-based index of hyperemic microvascular resistance (h-MR_v) by using prototypes of a novel, dual-sensor (Doppler velocity and pressure)–equipped guidewire before and after PCI to test this hypothesis.

Methods and Results— Aortic pressure, flow velocity (h-v), and pressure (h-P_d) distal to 24 coronary lesions were measured simultaneously during maximal hyperemia induced by intracoronary adenosine. Measurements were obtained in the reference vessel before PCI and in the target vessel before and after PCI, stenting, and ultrasound-guided, upsized stenting. h-P_d increased from 57.9±17.0 to 85.5±15.6 mm Hg, and h-MR_v (ie, h-P_d/h-v) decreased from 2.74±1.40 to 1.58±0.61 mm Hg · cm^–1 · s after stenting (both P<0.001). The reduction in h-MR_v accounted for 34% of the decrease in total coronary resistance achieved by PCI. h-MR_v of the target vessel after PCI was lower than that of the corresponding reference vessel despite a higher h-P_d in the reference vessel (P<0.01). Post-PCI baseline MR_v was correlated with baseline P_d before PCI (P<0.01).

Conclusions— PCI-induced restoration of P_d resulted in a reduction of h-MR_v in accordance with the pressure dependence of h-MR_v. The decrease in h-MR_v to a level below that of the corresponding reference vessel in the immediate post-PCI period and a lowered baseline MR_v suggest microvascular remodeling induced by long-term exposure to a low-pressure environment.

Key Words: angioplasty • hemodynamics • microcirculation • pressure • coronary disease • stenosis

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