Optimized stent implantation according to intracoronary Doppler-derived parameters

Abstract

The introduction of guidewires equipped with sensors for measurement of intracoronary Doppler flow and pressure allows direct evaluation of the result of percutaneous transluminal coronary angioplasty (PTCA) on coronary hemodynamics. Single-center studies have shown that stent implantation can be optimized using intracoronary-measured blood flow velocity (coronary flow reserve [CFR]) and pressure (fractional flow reserve [FFR]) parameters. 1,2 Furthermore, recent studies have shown that an optimized stent implantation according to Doppler flow parameters (CFR and relative CFR) yields an excellent clinical outcome. 3,4 In the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, optimized balloon angioplasty using angiographic and Doppler flow parameters was followed by stent implantation in a subset of patients. 5 This post hoc analysis examines optimal cutoff values for angiographic and Doppler flow parameters to predict long-term (12 months) clinical outcome after stent implantation. ••• The study population of this post hoc analysis consisted of 187 patients with stable or unstable angina pectoris undergoing Doppler-guided stent implantation in the setting of a multicenter study for the treatment of a single de novo coronary stenosis (DEBATE II). 5 Briefly, patients with 1 major native coronary artery and normal left ventricular function that were eligible for PTCA were included in this study. In the DEBATE II study, 620 patients were first randomized to guided balloon angioplasty (n 523) or direct stent implantation (n 97). In the guided balloon angioplasty arm, the operators were urged to obtain an optimal result predefined as a diameter stenosis 35% and a CFR 2.5. Bailout stenting was performed in 129 patients, and 15 patients were excluded because of technical reasons. The patient population of this substudy consisted of 187 of the remaining 379 patients who underwent stent implantation after a second randomization, irrespective of the result after balloon angioplasty. Coronary cineangiography was performed using standard procedures. All cine films were analyzed by an independent core laboratory without