Effect of Guiding Catheter Extubation During Physiological Assesment of Stenosis

Salma Raghad Karim*, Jelmer Sybren Westra, Laust Dupont Rasmussen, Ashkan Eftekhari, Martin Sejr-Hansen, Simon Winther, Morten Bøttcher, Evald Høj Christiansen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Extubation of the coronary guiding catheter may affect flow and pressure measurements in the coronary vessel during invasive coronary angiography (ICA).

AIM: This study aims to investigate the impact of guiding catheter extubation on fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR).

METHODS: This predefined subgroup analysis of the Dan-NICAD 2 study included patients with chronic coronary syndrome referred to ICA based on a coronary computed tomography angiography. Thermodilution was performed in all vessels evaluated with 30%-90% diameter stenosis on a visual estimate. The primary endpoints were FFR, CFR, and IMR changes when the guiding catheter was extubated from the coronary ostium. Three-dimensional quantitative coronary angiography analysis was conducted to evaluate whether the proximal flow area, defined as the area of the guiding catheter subtracted from the area of the vessel ostium, correlated with the changes in FFR, CFR, and IMR.

RESULTS: In 84 patients, coronary physiological measurements were performed twice: once with the guiding catheter intubated and once extubated. FFR decreased during guiding catheter extubation (0.82 ± 0.09 vs. 0.80 ± 0.10) with a mean difference of 0.02, 95% CI [0.01-0.03], p < 0.001. Following extubation, eight patients (8.7%) showed FFR values shifting from > 0.80 to ≤ 0.80. IMR increased during guiding catheter extubation (16.8 ± 8.50 vs. 21.4 ± 16.1) with mean difference of 4.67 [95% CI 1.74-7.60], p = 0.002. No significant changes in CFR were observed; intubated 3.09 ± 1.31 vs 2.84 ± 1.30; difference mean 0.25, [95% CI -0.07 to 0.56], p = 0.12. No significant correlations were found between the proximal flow area and the difference in FFR, CFR, and IMR from intubated to extubated: (r -0.14, p = 0.23), (r -0.11, p = 0.34), and (r -0.16, p = 0.17), respectively.

CONCLUSION: Extubating the guiding catheter decreased FFR and increased IMR. This resulted in an FFR decrease from > 0.80 to ≤ 0.80 in 8.7% of patients. CFR remained unchanged. No significant correlation was found between FFR/IMR changes and proximal flow area.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
Number of pages10
ISSN1522-1946
DOIs
Publication statusE-pub ahead of print - 30 Dec 2024

Bibliographical note

© 2024 Wiley Periodicals LLC.

Fingerprint

Dive into the research topics of 'Effect of Guiding Catheter Extubation During Physiological Assesment of Stenosis'. Together they form a unique fingerprint.

Cite this