Angiography and coronary function, a clinical approach

Coronary angiography has the potential to determine coronary function in addition to merely showing coronary anatomy. In this thesis, we describe several facets of angiographic evaluation of coronary flow velocity and function. Measurement of the length of the coronary vessels by means of a guide wire or a 3D angiography-based computer model permits calculation of coronary flow velocity, volume flow, and coronary resistance. In addition, the frame count reserve (FCR), an angiographic method that does not require use of an intracoronary guide wire, can be used as an estimate of coronary flow reserve. This can be performed in an automated way by use of a 4D model, based on coronary angiography. In the setting of primary PCI for STEMI, auxiliary therapeutic options may help to optimize coronary flow. As shown in this thesis, the administration of adenosine and the aspiration of distally embolized thrombi are methods that should be considered to improve coronary flow after primary PCI. To assess myocardial reperfusion in such patients, ST segment resolution on the ECG early after PCI may be used.