圧センサー付きガイドワイヤーによる冠動脈楔入圧と冠側副血行との関係

Relationship between Coronary Collateral Flow and Coronary Wedge Pressure using Pressure GuidelTM

　Pressure guide^TMを用いてPTCA中の冠動脈楔入圧（CWP）を測定し，造影上の側副血行との関係を検討した．待機的PTCA 40例をRentrop分類に準じ4群に分類したところ，CWP（平均値）は16.9±8.4mmHg（Rentrop−0），18.3±9.5mmHg（Rentrop−1），39.4±25.1mmHg（Rentrop−2），45.5±13.1mmHg（Rentrop−3）となった．CWP所見からみると，側副血行を介した虚血心筋への血流効果はrecipient vesselが造影されるか否かで明瞭に区別された．また，バルーン拡張10秒後および60秒後のCWPは各群とも変化せず，recruita—ble collateral症例も同様であった．したがって，冠灌流圧からはrecruitable collateralは1分程度の完全閉塞には無効と考えられた．Pressure guide^TM　によるCWP測定はPTCA時に容易に施行可能で，冠動脈造影による肉眼的評価に比べてより生理的な灌流状態の把握が可能と考えられた．

The purpose of this study was to estimate coronary collateral pathways by quantitatively measuring coro-nary wedge pressure (CWP). A fiberoptic pressure sen-sor mounted on a 0.018 inch guidewire (Pressure Guide^TM) was used to measure CWP in 40 patients undergoing percutaneous transluminal coronary angio-plasty (PTCA). Forty cases were angiographically se-parated into four groups (Rentrop-0 to 3) by Rentropclassification. A Pressure Guide^TM fiberoptic sensor was positioned distal to the stenosis and CWP was recorded during balloon inflation. The average CWP in Rentrop-3 (45.5±13.1mmHg) and Rentrop-2 (39.4±25.1mmHg) groups with rich collaterals was significantly higher than in Rentrop-1 (18.3 ±9. mmHg) and Rentrop-0 (16.9 ±8.4mmHg) groups with poor collaterals. This result revealed that the effectiveness of coronary collateral pathways hinged on whether the recipient vessel was visualized by the opposite coronary angiography or not. No significant change in CWP was obtained between 10 and 60 seconds of balloon occlusion. CWP was not affected by recruitable collateral during 1 minute of controlled occlusion. Our results indicate that CWP measured by Pressure Guide^TM provide us with more useful and physiological information about coronary collateral circulation.