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(Circulation. 1998;98:2133-2140.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Immediate and Long-Term Effect of Balloon Angioplasty or Stent Implantation on the Absolute and Relative Coronary Blood Flow Velocity Reserve
From the Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
Correspondence to Jan J. Piek, MD, Department of Cardiology, B2-108, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands. E-mail j.j.piek{at}amc.uva.nl
Background—There is controversy regarding the immediate and long-term effects of PTCA on the coronary flow reserve.
Methods and Results—A total of 54 patients with 1-vessel disease
and normal left ventricular function were studied after
balloon angioplasty (n=34) or stent implantation (n=20). Distal
coronary blood flow velocity reserve (CFR) was defined as the
ratio of adenosine-induced hyperemic versus baseline
blood flow velocity with a 0.014-in Doppler guidewire. The relative
CFR was defined as the ratio of the distal CFR and the reference CFR
measured in the normal adjacent coronary artery.
Hemodynamic and angiographic measurements were
performed before and directly after balloon angioplasty or stent
implantation and at 6-month follow-up. CFR after PTCA 
2.5 was defined
as an impaired CFR. Immediately after PTCA, CFR improved toward the
range of the reference artery CFR. In both the balloon-treated and the
stent-treated groups, initial high CFR values decreased and impaired
CFR values increased at follow-up toward the values of the reference
CFR in patients without restenosis. Impaired CFR after balloon
angioplasty (33%) or stent implantation (58%) in patients without
restenosis was related to an increased baseline flow velocity
that normalized at follow-up. Patients with an increase of CFR after
stenting were characterized by an unaltered baseline flow velocity and
an increased adenosine-induced hyperemic flow
velocity.
Conclusions—An impaired CFR (2.5) is a frequent finding after
balloon angioplasty or stent implantation as a result of a high
baseline flow velocity. Normalization of impaired CFR at follow-up in
patients without restenosis was associated with a decline of
the baseline flow velocity after both balloon angioplasty and stent
implantation, supporting the contention that this phenomenon relates to
a slow recovery of autoregulation of the microvascular bed.
Key Words: angioplasty • stents • blood flow
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