Angioplastyka balonowa czy protezowanie wiencowe. Porownanie skutecznosci przy pomocy angiografii ilosciowej i wewnatrzwiencowych pomiarow doppleroiwskich

Background: Balloon angioplasty (PTCA) has been used successfully for more than 15 years, however, restenosis remains a main problem. Therefore, new methods have been introduced, including coronary stenting. The results of both procedures may be assessed using numerous techniques. The quantitative angiography and intracoronary Doppler velocimetry seem to be most suitable for this purpose. Aim: To compare the effects of PTCA with coronary stenting by means of quantitative angiography and intracoronary Doppler velocimetry. Methods: The study group consisted of 133 patients (100 males, mean age 56 ± 6 years) in whom quantitative angiography and intracoronary Doppler velocimetry were performed. Twelve vessels underwent coronary stenting, and 36 - PTCA. The remaining vessels were normal at angiography and served as a control group. Diameters of coronary segments and stenoses were measured with computer-assisted automatic quantitative angiographic system (ACA-DCI Philips, NL). The measurements of coronary blood flow velocities were performed at baseline and during papaverine-induced hyperemia by means of 0,018'' Doppler guidewire (Flo Wire, Cardiomedics Inc, CA). Results: PTCA and coronary stenting has caused a significant reduction of coronary stenosis but this effect was significantly more pronounced in patients who underwent stenting (the increase in vessel wall diameter from 1,1 ± 0,3 mm to 2,2 ± mm in the PTCA group and from 1,0 ± 0,2 mm to 2,7 ± 0,6 mm following stenting, p < 0,005 pre versus post, and p < 0,005 stent versus PTCA). The increase of the reference diameter was observed only in patients who underwent stenting. At baseline condition, blood flow velocity has normalised in both groups following PTCA or stenting, however, during hyperemia a significant increase in the blood flow was present only in patients with stems. Conclusion: Early effects of coronary stenting, assessed by means of quantitative angiography and intracoronary Doppler velocimetry, are superior to those obtained using coronary balloon angioplasty.