Normalization of coronary flow reserve by percutaneous transluminal coronary angioplasty

Fifteen patients undergoing routine follow-up angiography 5 months after successful percutaneous transluminal coronary angloplasty (PTCA) without angina and with normal exercise thallium scintigraphy were selected for analysis. The coronary flow reserves of these patients were compared with those of 24 patients with angiographically normal coronary arteries to establish whether PTCA can restore to normal the coronary flow reserve of patients with chronic coronary artery disease. The quantitative cineangiographic changes and the concomitant alterations in coronary flow reserve as an immediate result of the PTCA and the subsequent changes 5 months later are described. Coronary flow reserve was measured with digital subtraction cineangiography. PTCA resulted in an increase in minimal obstruction area (mean ± standard deviation) from 0.8 ± 0.3 to 3.4 ± 0.7 mm2 and in coronary flow reserve from 1.0 ± 0.3 to 2.5 ± 0.6. Five months later a further substantial and significant (p < 0.05) late increase in obstruction area (3.8 ± 0.9 mm2) and flow reserve (3.6 ± 0.5) had occurred. In 11 of 15 patients coronary flow reserve was restored to normal. Changes in stenosis geometry are likely to be 1 of the major determinants of this late normalization of coronary flow reserve.