Effect of Guiding Catheter Extubation During Physiological Assesment of Stenosis.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-12-30 DOI:10.1002/ccd.31370

Salma Raghad Karim, Jelmer Sybren Westra, Laust Dupont Rasmussen, Ashkan Eftekhari, Martin Sejr-Hansen, Simon Winther, Morten Bøttcher, Evald Høj Christiansen

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Abstract

Background: Extubation of the coronary guiding catheter may affect flow and pressure measurements in the coronary vessel during invasive coronary angiography (ICA).

Aim: This study aims to investigate the impact of guiding catheter extubation on fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR).

Methods: This predefined subgroup analysis of the Dan-NICAD 2 study included patients with chronic coronary syndrome referred to ICA based on a coronary computed tomography angiography. Thermodilution was performed in all vessels evaluated with 30%-90% diameter stenosis on a visual estimate. The primary endpoints were FFR, CFR, and IMR changes when the guiding catheter was extubated from the coronary ostium. Three-dimensional quantitative coronary angiography analysis was conducted to evaluate whether the proximal flow area, defined as the area of the guiding catheter subtracted from the area of the vessel ostium, correlated with the changes in FFR, CFR, and IMR.

Results: In 84 patients, coronary physiological measurements were performed twice: once with the guiding catheter intubated and once extubated. FFR decreased during guiding catheter extubation (0.82 ± 0.09 vs. 0.80 ± 0.10) with a mean difference of 0.02, 95% CI [0.01-0.03], p < 0.001. Following extubation, eight patients (8.7%) showed FFR values shifting from > 0.80 to ≤ 0.80. IMR increased during guiding catheter extubation (16.8 ± 8.50 vs. 21.4 ± 16.1) with mean difference of 4.67 [95% CI 1.74-7.60], p = 0.002. No significant changes in CFR were observed; intubated 3.09 ± 1.31 vs 2.84 ± 1.30; difference mean 0.25, [95% CI -0.07 to 0.56], p = 0.12. No significant correlations were found between the proximal flow area and the difference in FFR, CFR, and IMR from intubated to extubated: (r -0.14, p = 0.23), (r -0.11, p = 0.34), and (r -0.16, p = 0.17), respectively.

Conclusion: Extubating the guiding catheter decreased FFR and increased IMR. This resulted in an FFR decrease from > 0.80 to ≤ 0.80 in 8.7% of patients. CFR remained unchanged. No significant correlation was found between FFR/IMR changes and proximal flow area.

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导管拔管在狭窄生理评估中的作用。

背景：在有创冠状动脉造影（ICA）中，冠状动脉导管的拔管可能会影响冠状血管内的流量和压力测量。目的：探讨导尿管拔管对分流血流储备（FFR）、冠状动脉血流储备（CFR）及微循环阻力指数（IMR）的影响。方法：这项预先确定的Dan-NICAD 2研究的亚组分析纳入了基于冠状动脉计算机断层血管造影的慢性冠状动脉综合征患者。热稀释对所有在视觉上狭窄30%-90%的血管进行评估。主要终点是当引导导管从冠状动脉口拔出时FFR、CFR和IMR的变化。进行三维定量冠状动脉造影分析，评估近端血流面积（定义为导管面积减去血管开口面积）与FFR、CFR和IMR的变化是否相关。结果：84例患者进行了2次冠状动脉生理测量：1次引导导管插管，1次拔管。导管拔管时FFR降低（0.82±0.09 vs. 0.80±0.10），平均差异为0.02,95% CI [0.01 ~ 0.03], p 0.80 ~≤0.80。导管拔管时IMR升高（16.8±8.50 vs. 21.4±16.1），平均差异为4.67 [95% CI 1.74 ~ 7.60], p = 0.002。CFR无明显变化；插管：3.09±1.31 vs 2.84±1.30；差异均值为0.25,[95% CI -0.07 ~ 0.56], p = 0.12。近端血流面积与插管和拔管期间FFR、CFR和IMR的差异无显著相关性：（r -0.14, p = 0.23）、（r -0.11, p = 0.34）和（r -0.16, p = 0.17）。结论：拔管可降低FFR，提高IMR。这导致8.7%的患者FFR从0.80下降到≤0.80。CFR保持不变。FFR/IMR变化与近端血流面积无显著相关性。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.