Comparison of myocardial perfusion reserve before and after coronary balloon predilatation and after stent implantation in patients with postangioplasty restenosis.

BACKGROUND

Stents provide a scaffold for coronary arteries after angioplasty and inhibit elastic recoil.

METHODS AND RESULTS

In 25 patients with postangioplasty restenosis of the left anterior descending artery, ECG-gated digital subtraction coronary angiograms were recorded at baseline and during hyperemia (12 mg papaverine IC) before and after balloon predilatation (PTCA), after implantation of a Palmaz-Schatz stent, and after 6 months. Densitometric evaluation revealed different time and density parameters to calculate two definitions of myocardial perfusion reserve (MPR1 and MPR2) and maximum flow ratio (MaxFR). Poststenotic MPR1 increased from 1.57 +/- 0.14 to 2.59 +/- 0.86 after PTCA and to 3.10 +/- 0.41 after stenting, with 2.90 +/- 0.65 at follow-up (ANOVA, P < .05), while reference MPR1 remained unchanged at 3.10 +/- 0.40. Poststenotic MPR2 increased from 1.36 +/- 0.28 to 2.50 +/- 1.20 and to 3.40 +/- 0.58, respectively, with 3.20 +/- 0.92 at follow-up (ANOVA, P < .05), while reference MPR2 remained unchanged at 3.40 +/- 0.60. MaxFR was 2.13 +/- 0.53 after PTCA, elasticity 2.83 +/- 0.35 after stenting, and 2.73 +/- 0.58 at follow-up (ANOVA, P < .05). A good correlation was found between minimal stenotic luminal diameter and MPR1 or MPR2 (r = .87 and r = .94) and between luminal gain and MaxFR (r = .75). A negative correlation was measured between recoil and MPR1, MPR2, and MaxFR (r = -.80, r = -.86, and r = -.83). At follow-up, a steeper correlation was found between MPR and minimal stenosis diameter (MPR1: slope, 0.52 versus 0.91; MPR2: slope, 1.48 versus 1.95) and between MaxFR and net lumen gain (slope, 0.78 versus 1.27).

CONCLUSIONS

Coronary stent implantation in patients with postangioplasty restenosis normalized poststenotic myocardial perfusion immediately as a result of a larger postprocedural lumen and a more pronounced inhibition of elastic recoil. After 6 months this benefit was sustained despite progressive lumen loss.