Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 Sep;91(9):1186-92.
doi: 10.1136/hrt.2004.048629.

Detection of coronary microembolisation by Doppler ultrasound during percutaneous coronary interventions

P Bahrmann  1 , H R Figulla, M Wagner, M Ferrari, A Voss, G S Werner
Affiliations

Detection of coronary microembolisation by Doppler ultrasound during percutaneous coronary interventions

P Bahrmann et al. Heart. 2005 Sep.

Abstract

Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals (HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention (PCI).

Methods and results: In an in vitro model, particle count and number of HITS detected by an intracoronary 0.014 inch Doppler wire were closely correlated (r = 0.97, p < 0.001). In the clinical study, 32 patients (mean (SD) age 61 (11) years; 23 men, nine women) with coronary artery disease were treated with balloon dilatation and stent implantation for a single vessel stenosis. In these patients HITS were detected during PCI in 84% (27 of 32). Reproducibility (r = 0.99, p < 0.001) and interobserver agreement (r = 0.84, p < 0.001) of HITS counts were significant. The number of HITS after stent implantation was significantly higher than after balloon dilatation (11 (7) v 2 (4), p < 0.001). Postprocedural coronary flow velocity reserve (CFVR) was < 2.0 in 55% (16 of 29) of all patients after balloon dilatation and < 2.0 in 23% (six of 26) after stent implantation. The number of HITS after stent implantation did not differ significantly between patients with CFVR < 2.0 and patients with CFVR > or = 2.0 (12 (8) v 10 (7), not significant).

Conclusions: Embolic particles can be detected as HITS by an intracoronary Doppler ultrasound device. Coronary microembolism is often observed during PCI, especially after stent implantation. However, the incidence of HITS alone does not explain a reduced CFVR after PCI.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Doppler images during percutaneous coronary interventions in patients. (A) High intensity transient signals (HITS) (arrows) after balloon dilatation. (B) HITS (arrows) after stent implantation. (C, D) Artefact signals (arrows).
Figure 2
Figure 2
Open loop system used in the in vitro studies. D indicates the tip of the Doppler guidewire.
Figure 3
Figure 3
Doppler images in the experimental open loop system with (A) HITS (arrow) representing a sand particle, and (B) without HITS for simulation of excavations.
Figure 4
Figure 4
Plot of linear regression analysis showing the relation between the number of particles counted and HITS detected (29 experiments, correlation r  =  0.97, p < 0.001).
Figure 5
Figure 5
Plots of linear regression analysis and mean difference. (A, B) Relation between the first and second number of HITS counted on different days by the same observer (n  =  32, correlation r  =  0.99, p < 0.001). (C, D) Comparison of number of HITS counted by two observers for analysis of interobserver agreement (n  =  32, correlation r  =  0.84, p < 0.001).
Figure 6
Figure 6
Number of HITS against coronary flow velocity reserve (CFVR) for all patients after balloon dilatation (black dots, correlation r  =  0.09, not significant) and stent implantation (white dots, correlation r  =  0.03, not significant).
See this image and copyright information in PMC

References

    1. Topol EJ, Leya F, Pinkerton CA, for the CAVEAT Study Group, et al. A comparison of coronary angioplasty with directional atherectomy in patients with coronary artery disease. N Engl J Med 1993;329:221–7. - PubMed
    1. Califf RM, Abdelmeguid AE, Kuntz RE, et al. Myonecrosis after revascularisation procedures. J Am Coll Cardiol 1998;31:241–51. - PubMed
    1. Brener SJ, Ellis SG, Schneider J, et al. Frequency and long-term impact of myonecrosis after coronary stenting. Eur Heart J 2002;23:869–76. - PubMed
    1. Abdelmeguid AE, Topol EJ, Whitlow PL, et al. Significance of mild transient release of creatine kinase-MB fraction after percutaneous coronary interventions. Circulation 1996;94:1528–36. - PubMed
    1. Ravklide J, Nissen H, Mickley H, et al. Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris. Am Heart J 1994;127:13–20. - PubMed

Publication types

MeSH terms