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(Circulation. 2000;102:e22.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Helical Velocity Patterns in a Human Coronary Artery

A Three-Dimensional Computational Fluid Dynamic Reconstruction Showing the Relation With Local Wall Thickness

G. Van Langenhove, MD; J. J. Wentzel, PhD; R. Krams, MD; C. J. Slager, PhD; J. N. Hamburger, MD; P. W. Serruys, MD

From the Interventional Cardiology (G.V.L., J.N.H., P.W.S.) and Hemodynamics (J.J.W., R.K., C.J.S.) Departments, Thoraxcenter, University Hospital Dijkzigt, Rotterdam, Netherlands, and Interuniversity Cardiology Institute of The Netherlands.

	Introduction

 
A74-year-old man was referred to our catheterization laboratory for elective angioplasty of the right coronary artery (RCA). One year earlier, he had suffered an acute inferior myocardial infarction, which was successfully treated with intravenous streptokinase. Only minor creatinine phosphokinase elevations were found. Since that time, however, the patient had frequently experienced exertional angina, Canadian Cardiovascular Society class 2. Because maximal antianginal medical therapy did not end these episodes, diagnostic coronary and left ventricular angiograms were performed. These showed a normal left ventricular contraction pattern. The left coronary arteries revealed no significant stenoses. The RCA showed a proximal stenosis of 90%.

The lesion was crossed with a hydrophilic guidewire and was predilated. A 4.0x13-mm self-expandable Wallstent (Schneider Co) was implanted for optimization of the angioplasty result (as verified with intracoronary ultrasound [IVUS]). Because the stent was insufficiently appositioned, poststenting balloon inflations were applied to further optimize the angiographic and ultrasonic results. After this successful intervention, no rise in creatinine phosphokinase was seen. The day after the procedure, the patient was dismissed from the hospital.

Six months later, a control angiogram was performed. Since the original procedure, the patient had remained free of angina. Coronary anatomy was assessed through both biplane angiography and IVUS. No angiographic restenosis at the stented site was seen; IVUS revealed only mild neointimal hyperplasia (Figure 1).

View larger version (70K): [in this window] [in a new window]   Figure 1. Left anterior oblique view of a stented right coronary artery (A) with IVUS images showing (from top to bottom) reference segment with slight intimal hyperplasia, focal fibrocalcific plaque, . . . [Full Text of this Article]