Author + information
- Kojiro Miki,
- Kenichi Fujii,
- Daizo Kawasaki,
- Masashi Fukunaga,
- Hiroto Tamaru,
- Takahiro Imanaka,
- Masahiko Shibuya,
- Motomaru Masutani,
- Mitsumasa Ohyanagi and
- Tohru Masuyama
Coronary flow reserve implies the ability of resistance vessels to dilate in response to increments in myocardial oxygen demand, and is normally 4.0–6.0 for normal adults. However, vascular flow reserve (VFR) and the adequate dose of pharmacologic agents to achieve maximum hyperemia in lower extremity peripheral artery are not fully elucidated.
Ten limbs of the patients in whom flow–velocity measurement was obtained in the nonstenotic superficial femoral arteries (SFA) were studied. VFR was evaluated by the thermodilution method with 0.014–inch pressure/temperature sensor–tipped–guidewires at baseline and during hyperemia induced by incremental dose of intra–arterial (IA) papaverine (10mg, 20mg, 30mg, and 40mg). VFR value was calculated as the ratio between baseline and hyperemic flow velocity.
High doses of intra–arterial papaverine were well tolerated, with no side effects. No pressure drop was observed with increasing IA papaverine doses. VFR values at maximal hyperemia distributed widely (2.19 to 7.69, average 4.85) and did not reach 3.0 in 3 patients (30%) despite angiographically normal SFA. VFR increased with increasing IA papaverine infusion doses, however no further increase was observed after 30mg (Figure).
The ability of resistance vessels to dilate in response to increments in muscle oxygen demand in lower extremity varied between individuals. A dose of papaverine up to 30mg is safe and can be used to achieve a maximum vasodilatation for SFA.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Endovascular Intervention
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2109–226
- 2013 American College of Cardiology Foundation