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Published on: May 14, 2013
The influence of the presence of collaterals on restenoses after PTCA
P Probst1, C Baumgartner, M Gottsauner-Wolf
1Cardiology University Clinic, University of Vienna, Austria.
Insights
The presence of coronary collaterals after percutaneous transluminal coronary arteriography (PTCA) is linked to a higher risk of restenosis. Patients with collaterals experienced more restenosis within six months post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Percutaneous transluminal coronary arteriography (PTCA) is a common procedure for treating coronary artery disease.
- Restenosis, the re-narrowing of a treated artery, remains a significant challenge after PTCA.
- Coronary collaterals, which provide blood flow to ischemic areas, may influence long-term outcomes.
Purpose of the Study:
- To investigate the impact of coronary collateral status on long-term restenosis rates following successful PTCA.
- To determine if collateral scoring and coronary wedge pressure measurements can predict restenosis risk.
Main Methods:
- A cohort of 120 patients undergoing successful PTCA was studied, with 104 included based on adequate follow-up angiograms.
- Collateral status was assessed using a scoring system during PTCA, and coronary wedge pressure was measured in a subset of patients.
- Patients were categorized into restenosis (stenosis >50%) and non-restenosis (stenosis <50%) groups at six-month follow-up.
Main Results:
- Patients with collaterals showed a significantly higher incidence of restenosis (45.7%) compared to those without (26.1%).
- Lower coronary wedge pressure (<45 mmHg) was associated with a significantly lower restenosis rate (23.3%) than higher pressure (>45 mmHg, 52.6%).
- No significant differences were observed in clinical or procedural parameters between restenosis and non-restenosis groups.
Conclusions:
- The presence of coronary collaterals is an indicator of a high restenosis rate within six months after PTCA.
- Coronary wedge pressure may serve as a predictor for restenosis risk post-PTCA.
- Further research is warranted to understand the mechanisms linking collaterals to restenosis and to develop targeted interventions.
Abstract:
To assess the influence of collaterals on the long-term follow-up after successful percutaneous transluminal coronary arteriography (PTCA), 120 consecutive patients were studied. Of these, 104 (87%) had an adequate reangiogram and were included. At the time of PTCA the collaterals were estimated by a scoring system. In addition, the coronary wedge pressure was measured in 49 patients six months after PTCA, a follow-up angiogram was performed, and the patients were split up into a group with restenoses (stenosis greater than 50%), 34 patients (32.7%); and a group without restenoses (stenosis less than 50%), 70 patients (67.3%). A total of 35 patients (30.7%) had collaterals. A comparison between both groups showed no significant differences in clinical parameters (age, angina duration, vessel involvement, lipids, blood sugar, and blood pressure), and stenoses-related parameters (degree of stenoses, eccentricity, balloon size, inflation pressure, dissection, gradient after dilatation, and residual stenoses). Patients with collaterals had a significantly higher incidence of restenoses than those without collaterals (45.7% vs. 26.1%, p less than 0.05). Patients with wedge pressure of less than 45 mmHg (n = 30) had a significantly lower restenosis rate (23.3%) than patients with a coronary wedge pressure of greater than 45 mmHg (n = 19) (restenosis rate 52.6%). It is concluded that the presence of collaterals indicates a high restenosis rate after PTCA within 6 months.
