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. 1989;16(3):195–203.

Transcatheter Coronary Artery Diagnostic Techniques including Impedance-Catheter and Impedance-Guidewire Measurement of Absolute Coronary Blood Flow

Robert A Vogel 1, Lisa W Martin 1
PMCID: PMC324882  PMID: 15227207

Abstract

Interventional cardiology requires precise assessment of coronary anatomy and physiology. Unfortunately, however, important interventional decisions are frequently made on the basis of arteriographic data alone. Increasing evidence suggests that visual interpretation of coronary arteriographic studies is irreproducible, inaccurate, and poorly predictive of coronary physiology. Moreover, arteriography is of little value in assessing endothelial ulceration and mural thrombus, which are important pathophysiologic features of unstable angina and acute myocardial infarction.

In response to these limitations, several diagnostic transcatheter techniques have been developed that allow more complete assessment of coronary physiology and function. These include fiberoptic angioscopy, reflection spectroscopy (which can combine automated laser therapy with diagnosis), ultrasonic catheterization, and translesional gradient determination. Doppler catheterization permits the assessment of overall coronary flow reserve with the aid of induced hyperemia, whereas subselective digital radiography allows the evaluation of regional coronary flow reserve.

The coronary flow reserve, however, may be falsely lowered immediately after balloon dilation, because of endothelial injury, repeated ischemia, or the administration of vasoactive drugs. To circumvent this problem, we have developed impedance-catheter and impedance-guidewire systems that, by applying impedance technology and the principles of indicator dilution, are capable of measuring absolute coronary blood flow. For a flow indicator, we use 0.5 mL of glucose solution (D5W), which has little effect on intrinsic blood flow. The validity of this approach has been demonstrated in experimental and clinical studies. The impedance guidewire is less obstructive than the catheter system, so it probably will become the method with clinical application. (Texas Heart Institute Journal 1989;16:195-203)

Keywords: Blood flow velocity

Keywords: coronary flow, absolute

Keywords: coronary artery physiology

Keywords: coronary artery disease

Keywords: interventional cardiology

Keywords: intraluminal devices, coronary artery

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brown B. G., Bolson E., Frimer M., Dodge H. T. Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation. 1977 Feb;55(2):329–337. doi: 10.1161/01.cir.55.2.329. [DOI] [PubMed] [Google Scholar]
  2. Brown B. G., Gallery C. A., Badger R. S., Kennedy J. W., Mathey D., Bolson E. L., Dodge H. T. Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: quantitative angiographic observations. Circulation. 1986 Apr;73(4):653–661. doi: 10.1161/01.cir.73.4.653. [DOI] [PubMed] [Google Scholar]
  3. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  4. Detre K. M., Wright E., Murphy M. L., Takaro T. Observer agreement in evaluating coronary angiograms. Circulation. 1975 Dec;52(6):979–986. doi: 10.1161/01.cir.52.6.979. [DOI] [PubMed] [Google Scholar]
  5. Fisher L. D., Judkins M. P., Lesperance J., Cameron A., Swaye P., Ryan T., Maynard C., Bourassa M., Kennedy J. W., Gosselin A. Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS). Cathet Cardiovasc Diagn. 1982;8(6):565–575. doi: 10.1002/ccd.1810080605. [DOI] [PubMed] [Google Scholar]
  6. Forrester J. S., Litvack F., Grundfest W., Hickey A. A perspective of coronary disease seen through the arteries of living man. Circulation. 1987 Mar;75(3):505–513. doi: 10.1161/01.cir.75.3.505. [DOI] [PubMed] [Google Scholar]
  7. Gould K. L., Lipscomb K., Hamilton G. W. Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol. 1974 Jan;33(1):87–94. doi: 10.1016/0002-9149(74)90743-7. [DOI] [PubMed] [Google Scholar]
  8. Gould K. L. Percent coronary stenosis: battered gold standard, pernicious relic or clinical practicality? J Am Coll Cardiol. 1988 Apr;11(4):886–888. doi: 10.1016/0735-1097(88)90227-6. [DOI] [PubMed] [Google Scholar]
  9. Gould K. L. Pressure-flow characteristics of coronary stenoses in unsedated dogs at rest and during coronary vasodilation. Circ Res. 1978 Aug;43(2):242–253. doi: 10.1161/01.res.43.2.242. [DOI] [PubMed] [Google Scholar]
  10. Grüntzig A. R., Senning A., Siegenthaler W. E. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979 Jul 12;301(2):61–68. doi: 10.1056/NEJM197907123010201. [DOI] [PubMed] [Google Scholar]
  11. Haraphongse M., Tymchak W., Burton J. R., Rossall R. E. Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty. Cathet Cardiovasc Diagn. 1986;12(2):80–84. doi: 10.1002/ccd.1810120203. [DOI] [PubMed] [Google Scholar]
  12. Harrison D. G., White C. W., Hiratzka L. F., Doty D. B., Barnes D. H., Eastham C. L., Marcus M. L. The value of lesion cross-sectional area determined by quantitative coronary angiography in assessing the physiologic significance of proximal left anterior descending coronary arterial stenoses. Circulation. 1984 Jun;69(6):1111–1119. doi: 10.1161/01.cir.69.6.1111. [DOI] [PubMed] [Google Scholar]
  13. Hodgson J. M., LeGrand V., Bates E. R., Mancini G. B., Aueron F. M., O'Neill W. W., Simon S. B., Beauman G. J., LeFree M. T., Vogel R. A. Validation in dogs of a rapid digital angiographic technique to measure relative coronary blood flow during routine cardiac catheterization. Am J Cardiol. 1985 Jan 1;55(1):188–193. doi: 10.1016/0002-9149(85)90326-1. [DOI] [PubMed] [Google Scholar]
  14. Judkins M. P. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967 Nov;89(5):815–824. doi: 10.1148/89.5.815. [DOI] [PubMed] [Google Scholar]
  15. Kern M. J., Deligonul U., Vandormael M., Labovitz A., Gudipati C. V., Gabliani G., Bodet J., Shah Y., Kennedy H. L. Impaired coronary vasodilator reserve in the immediate postcoronary angioplasty period: analysis of coronary artery flow velocity indexes and regional cardiac venous efflux. J Am Coll Cardiol. 1989 Mar 15;13(4):860–872. doi: 10.1016/0735-1097(89)90229-5. [DOI] [PubMed] [Google Scholar]
  16. Kirkeeide R. L., Gould K. L., Parsel L. Assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. VII. Validation of coronary flow reserve as a single integrated functional measure of stenosis severity reflecting all its geometric dimensions. J Am Coll Cardiol. 1986 Jan;7(1):103–113. doi: 10.1016/s0735-1097(86)80266-2. [DOI] [PubMed] [Google Scholar]
  17. Klocke F. J. Measurements of coronary blood flow and degree of stenosis: current clinical implications and continuing uncertainties. J Am Coll Cardiol. 1983 Jan;1(1):31–41. doi: 10.1016/s0735-1097(83)80008-4. [DOI] [PubMed] [Google Scholar]
  18. Laufer G., Wollenek G., Hohla K., Horvat R., Henke K. H., Buchelt M., Wutzl G., Wolner E. Excimer laser-induced simultaneous ablation and spectral identification of normal and atherosclerotic arterial tissue layers. Circulation. 1988 Oct;78(4):1031–1039. doi: 10.1161/01.cir.78.4.1031. [DOI] [PubMed] [Google Scholar]
  19. Legrand V., Mancini G. B., Bates E. R., Hodgson J. M., Gross M. D., Vogel R. A. Comparative study of coronary flow reserve, coronary anatomy and results of radionuclide exercise tests in patients with coronary artery disease. J Am Coll Cardiol. 1986 Nov;8(5):1022–1032. doi: 10.1016/s0735-1097(86)80377-1. [DOI] [PubMed] [Google Scholar]
  20. Leiboff R., Bren G., Katz R., Korkegi R., Ross A. Determinants of transstenotic gradients observed during angioplasty: an experimental model. Am J Cardiol. 1983 Dec 1;52(10):1311–1317. doi: 10.1016/0002-9149(83)90594-5. [DOI] [PubMed] [Google Scholar]
  21. Leimgruber P. P., Roubin G. S., Hollman J., Cotsonis G. A., Meier B., Douglas J. S., King S. B., Jr, Gruentzig A. R. Restenosis after successful coronary angioplasty in patients with single-vessel disease. Circulation. 1986 Apr;73(4):710–717. doi: 10.1161/01.cir.73.4.710. [DOI] [PubMed] [Google Scholar]
  22. Leon M. B., Lu D. Y., Prevosti L. G., Macy W. W., Jr, Smith P. D., Granovsky M., Bonner R. F., Balaban R. S. Human arterial surface fluorescence: atherosclerotic plaque identification and effects of laser atheroma ablation. J Am Coll Cardiol. 1988 Jul;12(1):94–102. doi: 10.1016/0735-1097(88)90361-0. [DOI] [PubMed] [Google Scholar]
  23. Little W. C., Constantinescu M., Applegate R. J., Kutcher M. A., Burrows M. T., Kahl F. R., Santamore W. P. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation. 1988 Nov;78(5 Pt 1):1157–1166. doi: 10.1161/01.cir.78.5.1157. [DOI] [PubMed] [Google Scholar]
  24. MacIsaac H. C., Knudtson M. L., Robinson V. J., Manyari D. E. Is the residual translesional pressure gradient useful to predict regional myocardial perfusion after percutaneous transluminal coronary angioplasty? Am Heart J. 1989 Apr;117(4):783–790. doi: 10.1016/0002-8703(89)90613-3. [DOI] [PubMed] [Google Scholar]
  25. Mancini G. B., Simon S. B., McGillem M. J., LeFree M. T., Friedman H. Z., Vogel R. A. Automated quantitative coronary arteriography: morphologic and physiologic validation in vivo of a rapid digital angiographic method. Circulation. 1987 Feb;75(2):452–460. doi: 10.1161/01.cir.75.2.452. [DOI] [PubMed] [Google Scholar]
  26. Marcus M. L., Skorton D. J., Johnson M. R., Collins S. M., Harrison D. G., Kerber R. E. Visual estimates of percent diameter coronary stenosis: "a battered gold standard". J Am Coll Cardiol. 1988 Apr;11(4):882–885. doi: 10.1016/0735-1097(88)90226-4. [DOI] [PubMed] [Google Scholar]
  27. Mizuno K., Arai T., Satomura K., Shibuya T., Arakawa K., Okamoto Y., Miyamoto A., Kurita A., Kikuchi M., Nakamura H. New percutaneous transluminal coronary angioscope. J Am Coll Cardiol. 1989 Feb;13(2):363–368. doi: 10.1016/0735-1097(89)90513-5. [DOI] [PubMed] [Google Scholar]
  28. Moise A., Lespérance J., Théroux P., Taeymans Y., Goulet C., Bourassa M. G. Clinical and angiographic predictors of new total coronary occlusion in coronary artery disease: analysis of 313 nonoperated patients. Am J Cardiol. 1984 Dec 1;54(10):1176–1181. doi: 10.1016/s0002-9149(84)80063-6. [DOI] [PubMed] [Google Scholar]
  29. Nichols A. B., Smith R., Berke A. D., Shlofmitz R. A., Powers E. R. Importance of balloon size in coronary angioplasty. J Am Coll Cardiol. 1989 Apr;13(5):1094–1100. doi: 10.1016/0735-1097(89)90267-2. [DOI] [PubMed] [Google Scholar]
  30. Nissen S. E., Elion J. L., Booth D. C., Evans J., DeMaria A. N. Value and limitations of computer analysis of digital subtraction angiography in the assessment of coronary flow reserve. Circulation. 1986 Mar;73(3):562–571. doi: 10.1161/01.cir.73.3.562. [DOI] [PubMed] [Google Scholar]
  31. O'Neill W. W., Walton J. A., Bates E. R., Colfer H. T., Aueron F. M., LeFree M. T., Pitt B., Vogel R. A. Criteria for successful coronary angioplasty as assessed by alterations in coronary vasodilatory reserve. J Am Coll Cardiol. 1984 Jun;3(6):1382–1390. doi: 10.1016/s0735-1097(84)80275-2. [DOI] [PubMed] [Google Scholar]
  32. Pandian N. G., Kreis A., Brockway B., Isner J. M., Sacharoff A., Boleza E., Caro R., Muller D. Ultrasound angioscopy: real-time, two-dimensional, intraluminal ultrasound imaging of blood vessels. Am J Cardiol. 1988 Sep 1;62(7):493–494. doi: 10.1016/0002-9149(88)90992-7. [DOI] [PubMed] [Google Scholar]
  33. Peterson R. J., King S. B., 3rd, Fajman W. A., Douglas J. S., Jr, Grüntzig A. R., Orias D. W., Jones R. H. Relation of coronary artery stenosis and pressure gradient to exercise-induced ischemia before and after coronary angioplasty. J Am Coll Cardiol. 1987 Aug;10(2):253–260. doi: 10.1016/s0735-1097(87)80004-9. [DOI] [PubMed] [Google Scholar]
  34. Roubin G. S., Douglas J. S., Jr, King S. B., 3rd, Lin S. F., Hutchison N., Thomas R. G., Gruentzig A. R. Influence of balloon size on initial success, acute complications, and restenosis after percutaneous transluminal coronary angioplasty. A prospective randomized study. Circulation. 1988 Sep;78(3):557–565. doi: 10.1161/01.cir.78.3.557. [DOI] [PubMed] [Google Scholar]
  35. SONES F. M., Jr, SHIREY E. K. Cine coronary arteriography. Mod Concepts Cardiovasc Dis. 1962 Jul;31:735–738. [PubMed] [Google Scholar]
  36. Serruys P. W., Juillière Y., Zijlstra F., Beatt K. J., De Feyter P. J., Suryapranata H., Van Den Brand M., Roelandt J. Coronary blood flow velocity during percutaneous transluminal coronary angioplasty as a guide for assessment of the functional result. Am J Cardiol. 1988 Feb 1;61(4):253–259. doi: 10.1016/0002-9149(88)90926-5. [DOI] [PubMed] [Google Scholar]
  37. Sherman C. T., Litvack F., Grundfest W., Lee M., Hickey A., Chaux A., Kass R., Blanche C., Matloff J., Morgenstern L. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med. 1986 Oct 9;315(15):913–919. doi: 10.1056/NEJM198610093151501. [DOI] [PubMed] [Google Scholar]
  38. Sibley D. H., Millar H. D., Hartley C. J., Whitlow P. L. Subselective measurement of coronary blood flow velocity using a steerable Doppler catheter. J Am Coll Cardiol. 1986 Dec;8(6):1332–1340. doi: 10.1016/s0735-1097(86)80305-9. [DOI] [PubMed] [Google Scholar]
  39. Vogel R. A. Assessing stenosis significance by coronary arteriography: are the best variables good enough? J Am Coll Cardiol. 1988 Sep;12(3):692–693. doi: 10.1016/s0735-1097(88)80058-5. [DOI] [PubMed] [Google Scholar]
  40. Vogel R. A., Bates E. R., O'Neill W. W., Aueron F. M., Meier B., Gruentzig A. R. Coronary flow reserve measured during cardiac catheterization. Arch Intern Med. 1984 Sep;144(9):1773–1776. [PubMed] [Google Scholar]
  41. Vogel R. A. The radiographic assessment of coronary blood flow parameters. Circulation. 1985 Sep;72(3):460–465. doi: 10.1161/01.cir.72.3.460. [DOI] [PubMed] [Google Scholar]
  42. Vogel R., LeFree M., Bates E., O'Neill W., Foster R., Kirlin P., Smith D., Pitt B. Application of digital techniques to selective coronary arteriography: use of myocardial contrast appearance time to measure coronary flow reserve. Am Heart J. 1984 Jan;107(1):153–164. doi: 10.1016/0002-8703(84)90150-9. [DOI] [PubMed] [Google Scholar]
  43. Wilson R. F., Laughlin D. E., Ackell P. H., Chilian W. M., Holida M. D., Hartley C. J., Armstrong M. L., Marcus M. L., White C. W. Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation. 1985 Jul;72(1):82–92. doi: 10.1161/01.cir.72.1.82. [DOI] [PubMed] [Google Scholar]
  44. Wilson R. F., Marcus M. L., White C. W. Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. Circulation. 1987 Apr;75(4):723–732. doi: 10.1161/01.cir.75.4.723. [DOI] [PubMed] [Google Scholar]
  45. Wilson R. F., White C. W. Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans. Circulation. 1986 Mar;73(3):444–451. doi: 10.1161/01.cir.73.3.444. [DOI] [PubMed] [Google Scholar]
  46. Zijlstra F., van Ommeren J., Reiber J. H., Serruys P. W. Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis? Circulation. 1987 Jun;75(6):1154–1161. doi: 10.1161/01.cir.75.6.1154. [DOI] [PubMed] [Google Scholar]

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