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Coronary collateral size, flow capacity, and growth: estimates from the angiogram in patients with obstructive
Julia Rockstroh1, B Greg Brown
1Department of Medicine, Cardiology Division, University of Washington School of Medicine, Seattle, WA 98195, USA.
Insights
A new cineangiographic method accurately measures coronary collateral growth. This technique revealed significant collateral expansion and improved flow capacity over 10 years, particularly when angina resolved.
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Interventional Cardiology
Background:
- Assessing coronary collateral growth is crucial for clinical applications but current methods are limited.
- Stimulating coronary collateral circulation offers potential therapeutic benefits.
Purpose of the Study:
- To develop and validate a cineangiographic approach for quantifying coronary collateral lumen caliber and flow capacity.
- To assess changes in collateral growth and flow capacity over a decade in patients with occluded arteries.
Main Methods:
- A validated cineangiographic technique was used to measure collateral lumen diameter and estimate flow capacity.
- Measurements were performed on phantoms and in 13 patients with occluded arteries before and after 10 years of lipid therapy.
Main Results:
- The method achieved a precision of +/-0.10 mm for collateral diameter measurement.
- Over 10 years, patients showed a mean increase in collateral diameter (+16%), area (+64%), and estimated flow capacity (+214%).
- Disappearance of angina correlated with a significantly greater increase in collateral flow capacity.
Conclusions:
- Coronary collateral diameter and flow capacity can be reliably estimated using cineangiography.
- Collateral growth is associated with lipid therapy and specific lipid profiles.
- Improved collateral flow capacity is linked to angina symptom resolution.
Background:
Stimulation of coronary collateral growth has potential clinical value, yet techniques to assess such growth in patients are limited.
Methods And Results:
A cineangiographic approach to classify the dominant collaterals and to quantify their lumen caliber and flow capacity was developed and validated. For measurement of 0.4- to 1.5-mm-diameter phantoms, mean error ranged from -0.01 to +0.02 mm. To illustrate the utility of such a method, 52 collateral pathways were measured in 13 patients with 17 occluded arteries before and after 10 years of intensive lipid therapy. The mean variance, final sigma, of 9 separate measurements of each collateral was +/-0.101 mm. At pretreatment, collateral diameter averaged 0.50+/-0.11 mm (SD) (range, 0.3 to 1.4 mm) without tapering or central narrowing. Over 10 years, mean increase in diameter was +16% (P=0.028); in area, +64% (P=0.015); and in estimated flow capacity, +214% (P=0.009). Certain lipoprotein characteristics tended to predict collateral growth. Patients for whom angina disappeared during 10 years had a greater increase in flow capacity than those for whom it persisted (+331% versus 4%; P=0.05).
Conclusions:
Coronary collateral diameter can be estimated with a precision of 0.10 mm. Flow capacity of the network is well approximated by measurement of the 2 or 3 largest connections serving an occluded artery. Initial studies with this method show that disappearance of angina is significantly associated with growth in collateral flow capacity. Collateral growth tends to associate with lipid therapy and with certain in-treatment lipid measures.
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