Copyright © 2000 by the European Society of Cardiology.
Quantitatively assessed coronary collateral circulation and restenosis following percutaneous revascularization
Cardiology, Swiss Cardiovascular Center Bern, University Hospital Bern, Switzerland
revised January 10, 2000; accepted January 14, 2000
Abstract
Aims A high degree of collateral supply to a vascular area where a percutaneous transluminal coronary angioplasty (PTCA) has been performed represents a haemodynamic force competing with the antegrade flow through the dilated lesion. Therefore, our purpose was to determine whether patients with restenosis following PTCA have a higher collateral flow to the recipient vessel than patients without restenosis.
Methods and Results In 200 consecutive PTCA patients, an intracoronary pressure-derived collateral flow index (CFI) was determined quantitatively during balloon occlusion, using simultaneous measurements of the mean aortic pressure (Pao) and of the intracoronary pressure distal to the occluded stenosis (Poccl), as well as the estimated central venous pressure (CVP=5mmHg): CFI=(Poccl–CVP)/(Pao–CVP). Sixty-four patients had an angiographic follow-up examination after at least 2 months, and were subdivided into patients with restenosis (>50% diameter stenosis, n=34) and patients without restenosis (n=30). Patients with restenosis had a significantly higher collateral flow index at the initial coronary angiography than patients without restenosis (0·26±0·14 vs 0·12±0·09;P<0·0001).
Conclusions Patients with restenosis after PTCA show a more extended collateral supply to this recipient area than patients without restenosis. Well developed collaterals to a revascularized region are a risk factor for restenosis of the treated lesion.
Key Words: Coronary artery disease, coronary collateral circulation, intracoronary pressure measurements, angiography, percutaneous transluminal coronary angioplasty, restenosis
f1 Correspondence: Christian Seiler, MD, FACC, FESC, Cardiology, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland.
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