739-2 Intraaortic Balloon Pumping Augments Distal Coronary Blood Flow Provided Through Perfusion Balloon Catheters During High Risk PTCA

Abstract

Perfusion balloon catheters (PBC) utilized for PTCA deliver antegrade distal blood flow during balloon inflation, limiting ischemia and permitting potentially hazardous or prolonged dilatations useful in management of high risk procedures. Distal flow is passive via the catheter lumen and determined in part by perfusion pressure, which may limit distal blood flow delivery, especially with lower profile PBC. Intraaortic balloon pumping (IABP) has been shown to increase diastolic pressure and blood flow in non-stenosed coronary arteries. To quantitate whether distal blood flow delivery via PBC could be augmented using intraaortic balloon pumping (IABP), we measured distal coronary flow velocity using an 0.018” Doppler-tipped guidewire placed alongside an inflated PBC (Flowtrack 40; ACS, Inc) during PTCA in 5 patients (4 LAD, 1 LCX) during high risk PTCA. Distal average peak velocity (APV, cm/s). systolic peak velocity (SPV, cm/s) and diastolic peak velocity(DPV, cm/s)were quantitated and volumetric coronary blood flow (CBF, ml/min) derived (APV × 0.5 × distal angiographic cross sectional area × 60) during PBC inflation without and with IABP. Results (means ± SD):Empty CellAPVSPVDPVDistal CBFIABP OFF10.1 ± 38.1 ± 215.5 ± 715.7 ± 6IABP ON12.3 ± 47.6 ± 320.3 ± 719.0 ± 7p value0.010.460.0010.009 While not affecting SPV, IABP increased APV, DPV and CBF measured distal to the inflated PBC by means of 22%, 35% and 22%, respectively. We conclude that use of IABP can significantly augment distal blood flow delivery by PBC during PTCA. This augmented distal perfusion may provide a mechanism to further reduce ischemia and increase the safety of high risk PTCA.