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Published on: July 2, 2018
Determinants of collateral filling observed during sudden controlled coronary artery occlusion in human subjects
M Cohen1, W Sherman, K P Rentrop
1Department of Medicine, Mount Sinai School of Medicine, City University of New York, New York.
Insights
Coronary artery lesion severity predicts collateral circulation during angioplasty. Higher stenosis grades correlate with better collateral filling, protecting against myocardial ischemia in single vessel coronary disease patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Collateral circulation significantly impacts myocardial ischemia extent during coronary angioplasty.
- Patient-to-patient variability exists in collateral filling during sudden coronary occlusion.
- Predicting high-grade collateral filling is crucial for managing coronary artery disease.
Purpose of the Study:
- To identify clinical and angiographic predictors of high-grade collateral filling during coronary occlusion.
- To correlate baseline variables with collateral filling in patients undergoing angioplasty.
- To understand factors influencing collateral blood supply in single vessel coronary disease.
Main Methods:
- Sixty-seven patients with single vessel coronary disease undergoing angioplasty were studied.
- Collateral filling was assessed using a contralateral arterial catheter before and during balloon inflation.
- Baseline clinical data and angiographic variables, including lesion severity, were analyzed.
Main Results:
- Mean collateral filling grade increased significantly from 0.4 to 1.8 during balloon inflation (p=0.001).
- Patients with 95-99% stenosis showed at least grade 2 collateral filling, unlike those with <=80% stenosis.
- Lesion severity (r=0.76) and baseline collateral filling (r=0.50) positively correlated with collateral filling during inflation.
Conclusions:
- Baseline lesion severity is the primary independent predictor of collateral filling grade during coronary occlusion.
- Collateral circulation capacity during angioplasty is strongly associated with the degree of coronary stenosis.
- Understanding these predictors can aid in assessing risk and optimizing treatment in coronary angioplasty procedures.
Abstract:
Higher grades of collateral circulation limit the extent of myocardial ischemia observed during balloon inflation in patients with single vessel coronary disease undergoing coronary angioplasty. However, the grade of collateral filling during sudden coronary occlusion varies from patient to patient. To assess which characteristics may predict a high grade of collateral filling, baseline clinical and angiographic variables were correlated with the grade of filling during coronary occlusion in 67 patients (whose angina ranged from 1 week to 36 months in duration) undergoing left anterior descending or right coronary artery angioplasty. A second contralateral arterial catheter was used to assess the collateral filling that reached the vessel dilated before and during transient total occlusion by the angioplasty balloon. Thirty-six patients had a proximal stenotic lesion ranging in severity from 65 to 99%. On a 0 to 3 scale, mean collateral filling grade before inflation was 0.4 versus 1.8 during inflation (p = 0.001). All 19 patients with 95 to 99% stenosis had at least grade 2 collateral filling during inflation. In contrast, 18 of 21 patients with less than or equal to 80% stenosis had only grade 0 or 1 collateral filling during inflation. There were significant positive correlations between collateral grade during inflation and 1) baseline lesion severity (r = 0.76), 2) baseline collateral filling grade (r = 0.50), and 3) vessel dilated. There was no relation between collateral filling during inflation and age, gender, risk factors, duration of angina or proximal versus distal location of the lesion. Lesion severity was the only independent variable associated with collateral filling grade.(ABSTRACT TRUNCATED AT 250 WORDS)
