Name of the Procedure:

Intravascular Doppler Velocity and/or Pressure-Derived Coronary Flow Reserve Measurement During Coronary Angiography (Pharmacologically Induced Stress); Each Additional Vessel

Summary

This procedure measures blood flow and pressure in the coronary arteries using a Doppler sensor during coronary angiography, often under stress induced by medication. It assesses the functionality of these arteries in supplying blood to the heart.

Purpose

This test helps to evaluate if the coronary arteries, including any grafts, are delivering sufficient blood flow to the heart muscles. By noting changes during induced stress, doctors can diagnose coronary artery disease or other heart conditions and determine the need for interventions like stenting or bypass surgery.

Indications

• Chest pain (angina) or discomfort during exertion
• Suspected coronary artery disease
• Abnormal results in non-invasive stress tests
• Post-operative evaluation of coronary artery grafts
• Recurrent heart symptoms despite treatment

Preparation

• Fasting for 6-8 hours before the procedure
• Informing the doctor of any medications; some may need adjustment or discontinuation
• Blood tests and non-invasive stress tests may be required beforehand
• Allergy test for contrast dye used in angiography, if necessary

Procedure Description

1. The patient is taken to the angiography suite and lies on an examination table.
2. A local anesthetic is administered to numb the insertion site, typically in the groin or wrist.
3. A catheter is inserted and guided to the coronary arteries.
4. A small Doppler sensor on the catheter measures blood flow velocity and pressure in the arteries.
5. Medication is administered to induce stress, mimicking exercise conditions.
6. Enhanced measurements are taken to assess the coronary flow reserve.
7. The procedure is repeated for each additional vessel as needed.

Duration

Typically takes 30 minutes to an hour per vessel.

Setting

Performed in a hospital's catheterization laboratory (cath lab).

Personnel

• Interventional cardiologist
• Nursing staff
• Radiologic technologist
• Anesthesiologist or sedation specialist, if applicable

Risks and Complications

• Bleeding or bruising at the catheter insertion site
• Allergic reactions to contrast dye
• Arrhythmias or irregular heartbeats
• Coronary artery spasm
• Vessel damage or perforation
• Heart attack or stroke (rare)

Benefits

• Accurate assessment of coronary artery function
• Helps in making informed decisions about treatments or interventions
• Can prevent future heart attacks by identifying problem areas

Recovery

• Monitoring in a recovery area for a few hours post-procedure
• Instructions to avoid heavy lifting or strenuous activity for a few days
• Possible mild discomfort at the catheter insertion site
• Follow-up visits to assess overall heart health and discuss results

Alternatives

• Non-invasive stress tests (e.g., treadmill test, nuclear stress test)
• Computed Tomography Angiography (CTA)

• Magnetic Resonance Angiography (MRA)

  Pros and cons depend on patient-specific factors, test accuracy, and invasiveness.

Patient Experience

• Mild discomfort or pressure during catheter insertion
• Sensations of warmth or flushing when contrast dye is injected
• Temporary chest discomfort from induced stress medication
• Post-procedure soreness or bruising at insertion site

Pain management and comfort measures will be provided to ensure as comfortable an experience as possible.