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Washout collaterometry: a new method of assessing collaterals using angiographic contrast clearance during coronary
C Seiler1, M Billinger, M Fleisch
1Cardiology, Swiss Cardiovascular Centre Bern, University Hospital, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland. christian.seiler.cardio@insel.ch
Insights
The time it takes for contrast dye to clear from coronary collateral vessels after an occlusion is inversely related to blood flow. This new washout method accurately characterizes coronary collateral vessel function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary collateral vessels play a crucial role in myocardial protection during acute ischemia.
- Accurate characterization of collateral flow is essential for guiding interventions and predicting outcomes.
Purpose of the Study:
- To test if contrast medium washout time predicts collateral flow.
- To evaluate a new method, washout collaterometry, for assessing coronary collateral vessels.
Main Methods:
- Collateral flow index was measured using intracoronary pressure in 54 patients undergoing percutaneous transluminal coronary balloon angioplasty (PTCA).
- Washout collaterometry involved injecting contrast into a collateral vessel, occluding it, and counting heartbeats until contrast cleared.
- Patients were categorized by collateral sufficiency (sufficient vs. insufficient).
Main Results:
- Sufficient collaterals had higher flow indices and shorter contrast washout times compared to insufficient collaterals (p < 0.0001).
- A strong inverse correlation (r = 0.72, p < 0.0001) was found between washout time and collateral flow index.
- Washout within 11 beats showed 88% sensitivity and 81% specificity for identifying sufficient collaterals.
Conclusions:
- Washout collaterometry is a novel radiographic contrast washout technique.
- The method leverages the inverse relationship between collateral flow and contrast clearance time.
- Washout collaterometry appears to be an accurate approach for characterizing coronary collateral vessels.
Objective:
To investigate the hypothesis that the time to washout of radiographic contrast medium trapped distal to an occluded collateral receiving vessel is inversely related to collateral flow, and that this provides an accurate method for characterising coronary collaterals.
Methods:
An intracoronary pressure derived collateral flow index was determined in 54 patients undergoing percutaneous transluminal coronary balloon angioplasty (PTCA). The study group was subdivided according to whether the collateral vessels were sufficient (n = 17) or insufficient (n = 37) to prevent ECG signs of myocardial ischaemia during PTCA. Washout collaterometry-an angiographic washout method-was carried out simultaneously; after injection of radiographic contrast medium into the collateral receiving vessel followed immediately by vascular occlusion, the number of heart beats was counted until approximately half the length of the epicardial vessel was cleared of contrast.
Results:
The collateral flow index was higher (0.28 (0.09) v 0.12 (0.07); p < 0.0001) and the contrast washout time shorter (8.0 (2.9) v 17.5 (6.7) heart beats; p < 0.0001) in patients with sufficient versus insufficient collaterals. There was an inverse correlation between contrast washout time and collateral flow index (r = 0.72, p < 0.0001). Washout of contrast distal to the occluded vessel within 11 heart beats correctly determined sufficient and insufficient collaterals with 88% sensitivity and 81% specificity.
Conclusions:
Washout collaterometry is a new radiographic contrast washout method based on the inverse relation between collateral flow and the time to clearance of radiographic dye injected into the ipsilateral vessel during PTCA. It appears to be an accurate method of characterising coronary collateral vessels.
