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A clinical study on the effect of open chronic total occlusion on hemodynamics of collateral circulation donor
Bing Tian1,2, Wenzheng Li1, Zheng Wu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Insights
Percutaneous coronary intervention for left anterior descending chronic total occlusion improves right coronary artery hemodynamics. Fractional flow reserve and instantaneous wave-free ratio indicate significant collateral function improvement, especially in vessels with pre-PCI FFR <0.75.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hemodynamics
Background:
- Left anterior descending chronic total occlusion (LAD-CTO) presents a challenge in revascularization.
- Collateral circulation plays a crucial role in supplying blood to the ischemic myocardium.
- Assessing donor vessel function is vital for predicting outcomes after LAD-CTO intervention.
Purpose of the Study:
- To evaluate hemodynamic changes in right coronary artery (RCA) donor vessels before and after percutaneous coronary intervention (PCI) for LAD-CTO.
- To compare the utility of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in assessing donor vessel function.
- To determine the impact of LAD-CTO intervention on collateral circulation.
Main Methods:
- A prospective study involving 45 patients with LAD-CTO undergoing PCI.
- Measurement of FFR and iFR in RCA donor vessels before and after LAD-CTO intervention.
- Comparison of hemodynamic parameters between patients with pre-PCI FFR <0.75 and FFR ≥0.75.
Main Results:
- Successful LAD-CTO PCI was achieved in all 45 patients.
- Both FFR and iFR showed significant improvement in RCA donor vessels post-PCI (FFR: 0.73±0.083 to 0.77±0.073; iFR: 0.90±0.048 to 0.93±0.034).
- Patients with pre-PCI FFR <0.75 demonstrated a more pronounced increase in RCA flow reserve post-intervention (ΔFFR=0.076±0.057) compared to those with FFR ≥0.75 (ΔFFR=0.017±0.0088; P=0.0032).
Conclusions:
- FFR and iFR provide consistent assessment of RCA hemodynamic changes after LAD-CTO opening.
- LAD-CTO PCI significantly enhances collateral function in RCA donor vessels.
- The improvement in collateral circulation is more substantial in patients with severely compromised RCA function (pre-PCI FFR <0.75).
Objective:
This study applied pressure measurement to measure the hemodynamic changes in right coronary artery (RCA) donor vessels before and after the opening of the vessel in patients with left anterior descending chronic total occlusion (LAD-CTO) interventional therapy.
Methods:
A total of 45 patients with LAD-CTO were divided into two groups of percutaneous coronary intervention (PCI) to observe the hemodynamic changes (fractional flow reserve [FFR] and instantaneous wave-free ratio [iFR]) before and after opening the chronic total occlusion (CTO), in order to provide collateral circulating donor vessels to the CTO, and observe the changes in iFR and FFR. The results of these two measures were compared to determine the significance of the donor vascular function.
Results:
A total of 45 patients with LAD-CTO successfully underwent LAD-CTO interventional therapy, and were immediately measured for FFR and iFR of the donor vessels. The FFR changes before right coronary artery flow reserve (RCAFR) was 0.73±0.083, and after the operation, this was 0.77±0.073. The iFR changes before RCAFR was 0.90±0.048, and after the operation, this was 0.93±0.034. Before and after the opening of the RCA, the FFR change (ΔFFR) and iFR change (ΔiFR) were also correlated with r = 0.033 (0.041-0.568: P < 0.05). A total of 19 cases had a FFR value of <0.75 before the operation, and the average FFR before and after the PCI was 0.65±0.048 and 0.72±0.057, respectively. Furthermore, the ΔFFR was 0.076±0.057 (n = 19), and FFR was >0.75 in 26 cases. The ΔFFR was 0.017±0.0088 (n = 26). These two groups were compared, P = 0.0032 (P < 0.05).
Conclusion:
The FFR and iFR results were the same in terms of RCA hemodynamic changes, after the LAD-CTO was opened. For the RCA with a preoperative FFR of <0.75, the increase in RCAFR after LAD-CTO PCI was more obvious.
