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Published on: January 28, 2020
Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of
Maja Pirnat1, Arthur E Stillman2, Rainer Rienmueller3
1Radiology Department, University Medical Centre Maribor, Maribor, Slovenia. majapirnat@gmail.com.
Insights
Higher collateral circulation in chronic total occlusion (CTO) patients correlates with more viable heart muscle. Assessing collaterals via coronary angiography may help evaluate myocardial viability before percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Percutaneous coronary intervention (PCI) success for chronic total occlusion (CTO) has improved.
- Myocardial viability is crucial for functional improvement after PCI.
- Coronary collaterals play a key role in maintaining myocardial viability.
Purpose of the Study:
- To investigate the association between the degree of coronary collaterals and myocardial viability in CTO patients.
- To test the hypothesis that greater collateral development indicates more viable myocardium.
Main Methods:
- Compared collateral degree (Rentrop classification on conventional coronary angiogram) with transmural scar extent (cardiac MRI) in 38 CTO patients.
- Statistical analysis to determine the association between collateral grading and scar extent.
Main Results:
- A statistically significant inverse association was found between Rentrop collateral grade and transmural scar extent (p=0.001).
- Higher collateral degrees correlated with a greater ratio of viable to non-viable myocardium.
Conclusions:
- The degree of coronary collaterals is significantly associated with myocardial viability in CTO patients.
- Routine grading of collaterals during angiography may aid in assessing myocardial viability for CTO interventions.
Abstract:
The success rate of percutaneous coronary artery intervention (PCI) of chronic total occlusion (CTO) lesions have increased in the recent years. However, improvement of function is only possible when significant myocardial viability is present. One of the most important factors of maintaining myocardial viability is the opening and development of collaterals. Our hypothesis was that with a higher degree of collaterals more viable myocardium is present. In 38 patients we compared the degree of collaterals, evaluated with a conventional coronary angiogram (CCA) and graded by the Rentrop classification to transmural extent of the scar obtained in a viability study with magnetic resonance (MRI). We found a statistically significant association of the degree of collaterals determined with Rentrop method and transmural extent of the scar as measured by CMR (p = 0.001; Tau = -0.144). Additionally, associations showed an increase in the ratio between viable vs. non-viable myocardium with the degree of collaterals. Our study suggests that it may be beneficial to routinely grade the collaterals at angiography in patients with CTO as an assessment of myocardial viability.
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