Digital subtraction angiographic assessment of the coronary arteries and coronary flow reserve

Although intravenous digital subtraction angiography was originally intended as a means of performing lessinvasive peripheral angiography, this less invasive approach has not proven feasible for coronary artery studies. Digital imaging has, however, proven helpful for the immediate replay, enhancement and quantification of coronary arteriography and enables the performance of regional blood flow (coronary flow reserve) analysis. Flow analysis is clinically helpful in determining the hemodynamic significance of individual coronary stenoses, which cannot always be assessed even using quantitative stenosis measurements. One method of assessing flow reserve by digital means uses parametric images to display the timing (color coded) and density (intensity coded) of the contrast bolus as it transverses the regional myocardial circulation. Analysis of baseline and hyperemic condition parametric images provides quantitative regional flow reserve information.