Cyclic flow variations after angioplasty: A rare phenomenon predictive of immediate complications

Experimental studies and studies in human beings have indicated that cyclic flow variation (CFV) is a reliable marker of the formation of platelet aggregates and thus may be predictive of immediate complications after coronary angioplasty. In this study, the incidence and clinical relevance of CFV in a large patient population after elective percutaneous transluminal coronary angioplasty (PTCA) was assessed. One hundred two patients with one-vessel disease and no previous Q-wave myocardial infarction underwent angiographically successful PTCA of a single lesion of a major coronary artery. A Doppler guide wire inserted distal to the stenosis was used to monitor flow velocity continuously after PTCA for 15 minutes. In 94 (92%) of 102 patients, a stable and reliable Doppler signal could be recorded for 15 minutes after the procedure. CFV, defined as gradual decline in flow over several minutes followed by a sudden restoration to higher values, was observed in 4 patients. In 3 of these 4 patients, the occurrence of CFV was predictive of immediate complications (2 intracoronary thrombosis and 1 acute closure), whereas none of the patients without CFV (n = 90) showed acute closure during hospital stay. In conclusion, CFVs in patients after angiographically successful elective PTCA are rare (4.3%) but highly sensitive for the prediction of abrupt occlusion.