ABSTRACT
Coronary artery revascularization with percutaneous transluminal coronary angioplasty is an effective therapeutic procedure in the management of properly selected patients with coronary artery disease. For patient selection and assessment of procedure efficacy, a functional evaluation of stenosis is mandatory. As stated by Gruntzig at the dawn of the angioplasty era, ‘imaging postcatheterization permits evaluation of the physiologic significance of an observed lesion and to determine the potential effect of dilatation on perfusion distal to the lesion’.1 In addition, a preangioplasty imaging evaluation ‘provides a baseline for noninvasive postangioplasty monitoring of the procedure’s success. As with the patient who has undergone bypass surgery, subjective symptoms are usually a good guide, but are not sufficient for the longitudinal evaluation of the procedure’.1 The practical impact of stress echocardiography in assessing coronary angioplasty has been widely demonstrated.2-18 The main tasks of physiological testing in angioplasty patients can be summarized as follows:
• Anatomical identification of disease and geographical localization, with physiological assessment of stenosis of intermediate anatomical severity and identification of target lesion in multivessel disease
• Risk stratification to identify asymptomatic patients more likely to benefit, in terms of survival, from a revascularization procedure
• Identification of myocardial viability in region with dyssynergy at rest • Identification of restenosis or disease progression
It is also easy to assess the results of the revascularization procedure, which may be completely successful (with disappearance of inducible ischemia; slide 1, Figure 1) or partially successful (with persisting inducible ischemia; slide 2, Figure 2).
