Читать книгу Interventional Cardiology - Группа авторов - Страница 172

1 Anticoagulation: all invasive coronary physiological assessment requires unfractionated heparin to prevent thrombosis upon the wire; 50–100 IU/kg must be administered prior to any intracoronary wires being placed.

2 Epicardial Artery Stabilization: Adequate doses of intracoronary nitrates are essential prior to physiological measurement and should be given immediately after the guiding catheter has engaged and before the passage of the pressure wire. Doses can vary according to patient factors and blood pressure but 200–300 mcg aliquots is common; some operators use 1 mg. The purpose is to stabilize epicardial resistance and minimize micro‐vasospastic changes of the epicardial vessel which are triggered by the passage of the intracoronary wire. Such spam can artificially escalate the significance of a given stenosis. Prolonged pressure wire cases should have repeated doses of intracoronary nitrates. This is facilitated by using a manifold with ports readily available for intracoronary injections. Nitrates should also be given again for any physiological measurements made after PCI.

Nitrates do not cause significant or long‐lived hyperemia. Shortly after injection, it will be noted that translational gradients will increase because there is a temporary increase in flow, however, the flow returns to baseline state within 30 seconds. To mitigate against confusion this may cause, it is best practice to administer the nitrate before the pressure wire is passed.