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Early Thallium Imaging After Percutaneous Transluminal Coronary Angioplasty: Tomographic Evaluation During Adenosine-Induced Coronary Hyperemia

Philadelphia Heart Institute, Presbyterian Medical Center, Philadelphia, Pennsylvania

Correspondence: For reprints contact: Abdulmassih S. Iskandrian, MD, Philadelphia Heart Institute, Presbyterian Medical Center, 51 N. 39th St., Philadelphia, PA 19104.

ABSTRACT

This study examined the immediate results of ²⁰¹Tl imaging during adenosine-induced coronary hyperemia in 25 patients with one-vessel coronary artery disease, 4 ± 3 days percutaneous transluminal coronary angioplasty (PTCA). There were special features in our study: use of quantitative angiography and single-photon emission computed tomography (SPECT); a homogeneous group of patients (one-disease) and a uniform stress (adenosine infusion). As a group, quantitative coronary angiography showed a decrease in percent diameter stenosis from 72% ± 12% to 23% ± 14%, p < 0.001. The thallium images were normal in 17 patients and abnormal in eight patients. However, of the eight patients, four had residual stenosis either in a secondary branch or downstream; one patient had local dissection (residual stenosis could not be assessed reliably), two patients had >50% residual diameter stenosis, and one patient had previous Q-wave myocardial infarction with a corresponding fixed thallium defect. In each of the eight patients with an abnormal image, a logical explanation could be identified. Thus, our results suggest that maximum reactive coronary hyperemia returns to normal immediately after PTCA, and that abnormal thallium results are due to inadequate dilatation or associated lesions.

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