By Nico H. J. Pijls (auth.)
Coronary stream reserve is a practical degree of stenosis severity re flecting the built-in results of its geometry together with percentage stenosis, absolute lumen quarter, size and form. Its medical program has been basically qualitative in non-invasive, perfusion imaging. size of coronary circulation reserve in the course of regimen coronary arte riography has been an elusive aim. Transit time and indicator dilution suggestions for assessing coronary circulation reserve at cardiac catheteriza tion are linked to marked variability in comparison to microspheres or circulation meters, thereby making their use questionable compared to the precision of fine quantitative arteriography. Coronary circulation reserve measured by means of exact Doppler catheters as an accessory to coronary arte riography indicates in guy the worth of this built-in practical degree of stenosis severity and the restrictions of percentage diameter narrowing as a degree of its physiologic value. in spite of the fact that, Doppler catheters require extra instrumentation that isn't but a vital part of coronary arteriography and supply measures of absolute coronary circulation reserve purely. Relative greatest movement or relative circulate reserve has been demon strated to be an immense self reliant, complimentary descriptor of stenosis severity self sustaining of fluctuating hemodynamic stipulations. the strategy built for DSA by means of Nico Pijls, defined during this publication is the 1st process for assessing relative coronary movement reserve as part of regimen coronary arteriography by way of DSA. the idea and uncomplicated con cepts are good constructed, experimental validation thorough and scientific functions timely.
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Extra resources for Maximal Myocardial Perfusion as a Measure of the Functional Significance of Coronary Artery Disease: From a Pathoanatomic to a Pathophysiologic Interpretation of the Coronary Arteriogram
Sample text
1) Injection of contrast agent into a coronary artery as routinely performed during cardiac catheterization, is followed by opacification of the myocardium supplied by that particular artery and subsequent washout.
Digital coronary angiography: approaches using intravenous and direct methods. In G B J Mancini, editor, Clinical applications of cardiac digital angiography, pages 253-279. Raven Press, New York, 1988. [34] Nissen S E and Gurley J C. Assessment of the functional significance of coronary stenoses. is digital angiography the answer? Circulation, 81 :1431-1435, 1990. Chapter 4 Problems and Limitations in the Application of Video densitometry to Assess Coronary Blood Flow and Myocardial Perfusion As discussed in the former chapter, a number of efforts have been made to use indicator dilution theory to calculate flow through the coronary circulation.
Clinical need is present to compare flow before and after interventions, such as PTCA or long-lasting lipid lowering therapy. If, how- Chapter 4 43 ever, the functional significance of a coronary artery stenosis has been changed by the intervention, this will result immediately in compensatory changes in peripheral resistance - and therefore volume - of the distal vascular bed, again precluding comparison of flow. An approach which claimed to provide the solution of this problem was introduced by Vogel and coworkers several years ago [9, 10, 11, 12].