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Titolo:
CHANGES OF FLUID-DYNAMIC PARAMETERS IN PERIPHERAL STENOSES WITH TRANSCUTANEOUS INTERVENTIONS
Autore:
WELLNHOFER E; BIAMINO G; SAUER HU; TREBELJAHR A; STALKE J; RAGG C; OSWALD H; GOTZE S; FLECK E; FELIX R;
Indirizzi:
FREE UNIV BERLIN,UKRV,DHZB,DEPT INTERMAL MED,DIV CARDIOL ANGIOL,AUGUSTENBURGER PL 1 D-13353 BERLIN GERMANY FREE UNIV BERLIN,UKRV,DEPT RADIOL D-13353 BERLIN GERMANY
Titolo Testata:
European heart journal
, volume: 16, anno: 1995, supplemento:, J
pagine: 60 - 70
SICI:
0195-668X(1995)16:<60:COFPIP>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
PERCUTANEOUS REVASCULARIZATION; INTRAVASCULAR MEASUREMENT; DOPPLER GUIDEWIRE; FLOW VELOCITY; ARTERY FLOW; CORONARY; ULTRASOUND;
Keywords:
FLUID DYNAMICS; PTLA; PERIPHERAL VESSEL DISEASE; DOPPLER VELOCITY; STENOSIS; SHEAR STRESS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
25
Recensione:
Indirizzi per estratti:
Citazione:
E. Wellnhofer et al., "CHANGES OF FLUID-DYNAMIC PARAMETERS IN PERIPHERAL STENOSES WITH TRANSCUTANEOUS INTERVENTIONS", European heart journal, 16, 1995, pp. 60-70

Abstract

Peripheral vessels provide a useful in vivo haemodynamic model allowing evaluation of local intravascular lipid dynamics. Velocity measurements using a 0-018 inch Doppler-tipped angioplasty guidewire, quantitative angiography and laboratory data were gathered from 45 patients with a total of 48 percutaneous transluminal laser assisted angioplasties (PTLA) in the superficial femoral, in the iliac, in the popliteal artery and in the peroneal artery. From these darn, bloodflow, whole blood viscosity: Reynold's numbers Womersley numbers and shear stress were calculated, evaluated as to their change post PTLA and correlated with clinical improvement at early follow-up. The clinical result was quantified as categorial improvement according to the American Heart Association guidelines. The primary angiographic results of angioplasty were satisfactory in all patients Clinically 17/45 patients showed a marked, 6/45 a moderate 18/45 a minimal, and 4/45 no improvement. The mean values of maximal peak velocity at stenosis decreased from 235 +/- 28 cm.s(-1) to 84 +/- 8 cm.s(-1) after PTLA (P < 0.01). The minimal intmstenotic cross section increased from 7.7 +/- 0.9 to 21.9 +/- 1.6 mm(2) (P < 0.01). Mean trans-stenotic flow increased after intervention by about 50% (P < 0.01) and improved further by 135% after administration of adenosine triphosphosphate i.a. (P < 0.01). Reynold's numbers were elevated intrastenotically (1285 +/- 198) pre-intervention as compared to values proximal (564 +/- 81) and distal (449 +/- 66) to the stenosis and were reduced significantly (P < 0.05) at stenosis by PTLA, whereas values proximal 829 +/- 84 intra 773 +/- 107, distal (676 +/- 98). Shear stress, reflecting mechanical interaction between flow and vessel wall, was elevated at stenosis pre-intervention to 44 +/- 8.9 Pa and reduced at post-stenotic vessel sites to 2.4 +/- 0.5 Pa. PTLA caused a decrease in stenosis to 6.3 +/- 1 Pa (P < 0.01) and an increasedistally to 4.6 +/- 1 Pa (P < 0.01). Whereas in single stenoses removal of tile obstruction was associated with a significant (P < 0.05) increase in trans stenotic flow and shear stress distally, there was only attenuated increase distally remained low in those patients. Velocities and Reynold's numbers were lower in these vessels even pre PTLA. Residual flow, Reynold's number and minimal cross-section pre-intervention correlated significantly with clinical outcome. Pooling cases withno or minimal, as opposed to those with marked or moderate improvement, 81% of patients were correctly classified using the Reynold's numbers pre- and post-PTLA. Conclusion: Peak velocity monitoring is feasible and safe during angioplasty. Velocity provides clinically relevant physiological information in addition to angiography. Combining quantitative angiography, velocity measurements and laboratory data allow thecalculation of blood flow Reynold's numbers and shear stress, therebyproviding complex fluid dynamic information. Thus the evaluation of haemodynamics in single and multiple obstructions before and after intervention is improved fluid dynamic parameters pre- and post-PTLA are significantly correlated with clinical shorr-term result.

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Documento generato il 04/12/20 alle ore 19:56:32