Limitations of different methods to select the culprit lesion(s) in multivessel disease
| Nuclear scintigraphy |
| • No discrimination between several abnormalities within one coronary artery |
| • More severely diseased area masks other ischaemic areas |
| • False negative in cases of balanced disease |
| • Needs to be performed in another department |
| Quantitative coronary angiography |
| • Rapid, cheap, reproducible, no additional equipment needed, but… |
| • Poor correlation with flow impairment in individual lesions |
| • Reference segment often not normal in multivessel disease |
| Doppler flow imaging |
| • Large overlap between normal and pathologic values |
| • Strongly influenced by changes in heart rate and blood pressure |
| • No discrimination between several abnormalities, between diffuse and focal epicardial disease, or epicardial and microvascular disease |
| • Often frustrating and time consuming |
| Intravascular ultrasound |
| • Unequalled structural information about plaque and wall, but… |
| • In extended multivessel disease, IVUS shows disease everywhere and fails to give the necessary functional information about which individual lesions may be “culprit” |
| • Expensive, long learning curve, additional equipment mandatory, relatively time consuming |