Evaluation of Successful PTCA by Transstenotic Flow Velocity Ratios

Abstract

Doppler probes mounted on the tip of a guidewire allow the measurement of coronary blood flow velocities, not only proximal but also distal to stenoses eligible for percuta neous transluminal coronary angioplasty (PTCA). The objective of this study was to determine the improvement of transstenotic Doppler flow velocity ratios following PTCA and to investigate the possible impact on restenosis during follow-up control angiog raphy three months later. Doppler flow velocity measurements were performed in 29 patients with 29 stenoses eligible for PTCA. Results of PTCA were morphologically evaluated by computer-assisted quantitative coronary angiography (QCA) and measured hemodynamically by deter mining transstenotic Doppler flow velocity ratios. Successful PTCA according to QCA was present in all cases with a reduction of mean diameter stenosis from 66 ±8% to 35 ±7%. Resting spectral peak velocities and velocity integrals were markedly reduced distal to lesions (all P<0.001), resulting in mean transstenotic flow velocity and velocity integral ratios of less than 0.60 prior to PTCA. Owing to endoluminal enlargement, significant improvement of transstenotic Doppler ratios was observed in mean ratios greater than 0.90 (all P < 0.0001 ) . In patients with restenosis, transstenotic ratios following PTCA demonstrated a tendency to be smaller than in patients without restenosis. Transstenotic Doppler flow velocity ratios are diminished in severe coronary stenoses. Improvement of these ratios provides information on hemodynamic success of interven tional procedures. Thus, the determination of intracoronary Doppler flow velocity ratios contributes, in additon to angiographic estimation, to the evaluation of stenoses severity and success of interventional procedures.