Value of blood flow velocity assessment during peripheral percutaneous transluminal laser-assisted angioplasty.

Purpose: The aim of the study was to establish the prognostic value and clinical implications of blood flow velocity measurements by Doppler guide wires during peripheral laser-assisted percutaneous transluminal angioplasty (PTLA). Methods: 39 patients presenting with symptomatic peripheral arterial obstructive disease underwent angiography and blood flow velocity assessment by Doppler guide wire (0.018") prior to and following PTLA. Both quantitative angiography (QCA) for measurement of luminal diameters and Doppler assessment of maximum peak velocities (MPV) were performed 2 cm proximal, over and 2 cm distal to stenoses, The results were compared with the following clinical endpoints: 1. Short-term clinical improvement by AHA-criteria during first follow-up examination and 2. criteria for patency suggested by Rutherford [12] within 1 year (1-22 months). Results: Angiography demonstrated initial success of PTLA in all patients. Relative diameter stenosis decreased from 70 +/- 0.04% to 17 +/- 0.05%. Mean clinically category improved from 2.7 +/- 0.1 to 1.2 +/- 0.1 following intervention. Mean grade of clinical improvement was 2.8 +/- 0.1. 22/39 patients demonstrated event-free follow-up examinations. Doppler measurements of MPV post PTLA in the proximal reference segment correlated with clinical outcome. MPV greater than or equal to 90 cm/s was associated with good primary success, unlimited walking capacity and event-free follow-up. MPV greater than or equal to 70 cm/s predicted an improvement of short-term clinical outcome by 2 grades (predictive value 80%). MPV < 70 cm/s was associated with both minor primary clinical improvement (+/-0, +1) and increased incidence of restenosis during follow-up. Conclusion: Following PTLA, MPV adds information to angiographic success. MPV greater than or equal to 90 cm/s in a proximal reference segment following PTLA predicts good clinical outcome, whereas MPV <70 cm/s is associated with minor primary clinical success and increased rates of restenosis.