Coronary blood flow reserve response to left anterior descending coronary artery stenting and its value in predicting coronary restenosis.

Background: Heterogeneous results of coronary flow velocity reserve (CFVR) to percutaneous procedures have been reported and the impact of transesophageal echocardiographic evaluation of CFVR in predicting restenosis has not been completely established.

Methods And Results: We studied 20 control volunteers and 51 patients with left anterior descending coronary artery stenosis to determine the CFVR response to left anterior descending coronary artery stenting, the clinical markers of persistent CFVR impairment, and its value in predicting restenosis. Prestent CFVR was lower in the stenosis group than in control volunteers (1.89 +/- 0.66 vs 3.82 +/- 1.15; P <.001). Although there was a significant increase of CFVR after stenting (2.58 +/- 0.76; P <.001 vs prestent), it remained depressed in 53% of patients and was independently related to multivessel disease (odds ratio, 0.14; 95% confidence interval 0.03-0.55; P =.005), age (odds ratio, 1.07; 95% confidence interval 0.99-1.15; P =.056), and prestent CFVR (odds ratio, 3.78; 95% confidence interval 0.99-14.42; P =.051). CFVR measured both before and early after stenting did not differ between patients with and without restenosis.

Conclusions: CFVR impairment occurs in a large proportion of patients despite successful stenting and appears to be consequent of the extent of atherosclerotic coronary disease. Periprocedural CFVR conferred no predictive value for subsequent intrastent restenosis.