Poststenotic coronary blood flow following percutaneous transluminal coronary angioplasty

Poststenotic intracoronary flow velocity measurements both prior to and following percutaneous transluminal coronary angioplasty (PTCA) by use of a Doppler-tipped guidewire allow estimation of haemodynamic improvement due to interventional procedures. Since poststenotic coronary artery vasoconstriction routinely occurs after PTCA, haemodynamic improvement may be overestimated when measured by flow velocity alone. In 38 patients scheduled for elective PTCA in single vessel disease (left anterior descending = 19; left circumflex = 9; right coronary artery = 10) change of poststenotic coronary blood flow (CBF) was calculated by the combined use of intracoronary flow velocity measurement (average peak velocity: APV) and quantitative coronary angiography (cross sectional area: CSA) both prior to and following PTCA. Poststenotic coronary diameters revealed a small but significant decrease following PTCA (2.9 +/- 0.5 versus 2.7 +/- 0.5 mm, p < 0.001, 33 of 38 analysed vessels, i.e. 86.8%), whereas APV demonstrated a significant increase due to PTCA (17.0 +/- 8 versus 41.5 +/- 16, p < 0.001). Along with the increment in poststenotic flow velocity, poststenotic CBF increased highly significantly following PTCA (33 +/- 25 versus 73 +/- 41 ml min(-1), p < 0.001). In spite of a significant decrease in poststenotic coronary diameter, a highly significant increment of poststenotic flow due to PTCA can be demonstrated paralleling increment of poststenotic coronary Doppler-flow velocity.