[Measuring the intracoronary pressure gradient--value and methodologic limitations].

Abstract

Measurements of pressure gradients were performed in a fluid-filled model. The hydrostatically regulated perfusion pressure, as well as the diameter of the tube segments and the regulation of the flow by peripheral resistance, were comparable to conditions in human coronary arteries. Pressure gradients above 20 mm Hg were only measured with a reduction in cross-sectional area of more than 90%. Even after increasing the flow four-fold, which corresponds to the human coronary flow reserve, as well as after probing the stenosis with different catheters (2F-5F), gradients greater than 20 mm Hg were only recorded with high-grade stenoses (more than 80% reduction in cross-sectional area). The findings in this model demonstrate that measurement of pressure gradients allows only a quantitative differentiation between high-grade (greater than 80%) and low-grade (less than 80%) stenoses. The catheter itself can substantially contribute to the gradient by vessel obstruction, depending on the diameter of the catheter and of the coronary vessel. A quantitative assessment of the stenosis therefore requires knowledge of the pre- and post-stenotic vessel diameter as well as of the catheter diameter. However, pressure measurements during transluminal coronary angioplasty should not be abandoned. They can be useful to aid catheter positioning and to estimate dilatation efficacy. Moreover, measurement of coronary capillary wedge pressure during balloon expansion provides valuable information about the extent of collateralisation.