Karim Salma Raghad, Westra Jelmer Sybren, Rasmussen Laust Dupont, Eftekhari Ashkan, Sejr-Hansen Martin, Winther Simon, Bøttcher Morten, Christiansen Evald Høj
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
Catheter Cardiovasc Interv. 2025 Mar;105(4):735-744. doi: 10.1002/ccd.31370. Epub 2024 Dec 30.
Extubation of the coronary guiding catheter may affect flow and pressure measurements in the coronary vessel during invasive coronary angiography (ICA).
This study aims to investigate the impact of guiding catheter extubation on fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR).
This predefined subgroup analysis of the Dan-NICAD 2 study included patients with chronic coronary syndrome referred to ICA based on a coronary computed tomography angiography. Thermodilution was performed in all vessels evaluated with 30%-90% diameter stenosis on a visual estimate. The primary endpoints were FFR, CFR, and IMR changes when the guiding catheter was extubated from the coronary ostium. Three-dimensional quantitative coronary angiography analysis was conducted to evaluate whether the proximal flow area, defined as the area of the guiding catheter subtracted from the area of the vessel ostium, correlated with the changes in FFR, CFR, and IMR.
In 84 patients, coronary physiological measurements were performed twice: once with the guiding catheter intubated and once extubated. FFR decreased during guiding catheter extubation (0.82 ± 0.09 vs. 0.80 ± 0.10) with a mean difference of 0.02, 95% CI [0.01-0.03], p < 0.001. Following extubation, eight patients (8.7%) showed FFR values shifting from > 0.80 to ≤ 0.80. IMR increased during guiding catheter extubation (16.8 ± 8.50 vs. 21.4 ± 16.1) with mean difference of 4.67 [95% CI 1.74-7.60], p = 0.002. No significant changes in CFR were observed; intubated 3.09 ± 1.31 vs 2.84 ± 1.30; difference mean 0.25, [95% CI -0.07 to 0.56], p = 0.12. No significant correlations were found between the proximal flow area and the difference in FFR, CFR, and IMR from intubated to extubated: (r -0.14, p = 0.23), (r -0.11, p = 0.34), and (r -0.16, p = 0.17), respectively.
Extubating the guiding catheter decreased FFR and increased IMR. This resulted in an FFR decrease from > 0.80 to ≤ 0.80 in 8.7% of patients. CFR remained unchanged. No significant correlation was found between FFR/IMR changes and proximal flow area.
在有创冠状动脉造影（ICA）期间，冠状动脉引导导管的拔出可能会影响冠状动脉内的血流和压力测量。
本研究旨在探讨引导导管拔出对血流储备分数（FFR）、冠状动脉血流储备（CFR）和微循环阻力指数（IMR）的影响。
这项对Dan-NICAD 2研究的预定义亚组分析纳入了基于冠状动脉计算机断层扫描血管造影而接受ICA检查的慢性冠状动脉综合征患者。对所有目测直径狭窄30%-90%的血管进行热稀释法测量。主要终点是引导导管从冠状动脉口拔出时FFR、CFR和IMR的变化。进行三维定量冠状动脉造影分析，以评估近端血流面积（定义为血管口面积减去引导导管面积）与FFR、CFR和IMR变化之间是否存在相关性。
84例患者进行了两次冠状动脉生理测量：一次是引导导管插入时，一次是拔出时。引导导管拔出期间FFR降低（0.82±0.09 vs. 0.80±0.10），平均差值为0.02，95%CI[0.01-0.03]，p<0.001。拔出后，8例患者（8.7%）的FFR值从>0.80降至≤0.80。引导导管拔出期间IMR升高（16.8±8.50 vs. 21.4±16.1），平均差值为4.67[95%CI 1.74-7.60]，p=0.002。未观察到CFR有显著变化；插入时为3.09±1.31，拔出后为2.84±1.30；平均差值为0.25，[95%CI -0.07至0.56]，p=0.12。未发现近端血流面积与插入到拔出时FFR、CFR和IMR的差值之间存在显著相关性：分别为（r -0.14，p=0.23）、（r -0.11，p=0.34）和（r -0.16，p=0.17）。
拔出引导导管会降低FFR并升高IMR。这导致8.7%的患者FFR从>0.80降至≤0.80。CFR保持不变。未发现FFR/IMR变化与近端血流面积之间存在显著相关性。
