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PubMed1995

Comparison between regional myocardial perfusion reserve and coronary flow reserve in the canine heart.

Diameter stenosis and flow reserve are indices of morphological and functional severity of coronary artery stenosis. Flow reserve can be determined at coronary arterial or at myocardial level. In the presence of functional collateral circulation, coronary flow reserve and myocardial perfusion reserve may differ. We studied coronary flow, coronary flow reserve and myocardial perfusion reserve in an open chest dog model with intact collateral circulation, before and after induction of coronary artery stenosis. Coronary flow was determined with perivascular ultrasonic flow probes and myocardial perfusion reserve from digital angiographic images, in the stenotic as well as the adjacent non-stenotic coronary arteries. Before induction of a stenosis, a significant correlation existed between coronary flow reserve and myocardial perfusion reserve of the left anterior descending (r = 0.59; P < 0.005) and the left circumflex arteries (r = 0.84, P < 0.005). In stenotic arteries, coronary flow reserve and myocardial perfusion reserve decreased significantly (P < 0.005), but in the adjacent non-stenotic arteries coronary flow reserve was not affected. Myocardial perfusion reserve in the non-stenotic adjacent left anterior descending artery decreased significantly (P < 0.05) and no correlation was found between coronary flow reserve and myocardial perfusion reserve, whereas in the adjacent non-stenotic left circumflex artery there was no statistically significant decrease (4.1 +/- 1.6 --> 3.5 +/- 1.4) but there was a good correlation between coronary flow reserve and myocardial perfusion reserve (r = 0.85; P < 0.005). This study demonstrates that, in the presence of a stenosis and functioning collateral circulation, coronary flow reserve is not a reliable predictor of myocardial perfusion reserve; both parameters provide mutually complementary information.

Angiography, Digital Subtraction↗
PubMed1988

Preoperative evaluation of patients with extracranial carotid disease. Plethysmographic criteria for the use of a shunt, and for avoidance of surgery.

Eighty five angiographically studied patients (mean age 52) with carotid artery disease were preoperatively evaluated for the type and adequacy of their collateral circulation by the use of supraorbital photo-electric plethysmography (SPP). According to certain criteria we identified the candidates for surgery with or without shunt or for conservative treatment. Sixty patients presented evidence of extracranial collateral mainly from the ipsilateral superficial temporal artery (49 of 60), 11 patients revealed evidence of intracranial collateral mainly from the contralateral internal carotid artery (9 of 11), while in the rest, 14 patients, the source of the collateral circulation was undeterminable. Furthermore, an adequate circle of Willis was found in 67 patients and an inadequate one in the rest 7 (4 of 60, and 3 of 14). The majority of the surgically treated patients (74 of 81) were subjected to surgery without shunt (91%) while only 7 necessitated the use of a shunt (9%). No neurological complication was encountered and the single death (1.3%) was not directly related to the surgery itself. According to the present study, the careful preoperative determination of the collateral circulation, with the simple technique of SPP and the identification of patients at high risk under certain criteria could help the surgeon to decide about the advisability of a shunt or not and about the avoidance of surgery as well. This technique may be valuable where other more sophisticated forms of monitoring, such as EEG, evoked potentials or blood flow, are not readily available.

Adult↗