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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
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Changes in coronary collateral function after successful chronic total occlusion percutaneous coronary intervention
Danielle C J Keulards1, Osama Alsanjari2,3,4, Thomas R Keeble2,3
1Cardiology Department, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
Summary
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) successfully restores blood flow but leads to reduced collateral function over time. This decline in collateral function was observed regardless of the specific PCI technique used.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) utilizes advanced techniques like wire escalation and dissection/re-entry for recanalization.
- Understanding the impact of these interventions on coronary collateral function is crucial for patient outcomes.
Purpose of the Study:
- To evaluate changes in coronary collateral function following successful CTO PCI.
- To determine if the method of recanalization influences the regression of collateral function.
Main Methods:
- Prospective study of patients undergoing elective CTO PCI with viable myocardium in the CTO territory.
- Measurement of aortic pressure and distal coronary artery wedge pressure at rest and during hyperemia (using adenosine) to calculate collateral pressure index (CPIrest) and collateral fractional flow reserve (FFRcoll) immediately post-PCI and at 3-month follow-up.
Main Results:
- Successful CTO PCI resulted in a significant decrease in collateral function, evidenced by reduced wedge pressure, FFRcoll, CPIrest, and maximum collateral flow at 3 months compared to post-PCI measurements.
- Recanalization techniques included antegrade wiring (64.2%), antegrade dissection re-entry (8.6%), and retrograde dissection re-entry (27.1%).
- No significant correlation was found between the specific recanalization technique and the degree of collateral function reduction.
Conclusions:
- Coronary collateral flow significantly diminishes in the months following successful CTO PCI.
- This reduction in collateral function occurs independently of the recanalization strategy employed.
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