Coronary wedge pressure in relation to spontaneously visible and recruitable collaterals.

Abstract

Coronary angiography demonstrates only collateral arteries that are already in use (spontaneously visible collaterals). Percutaneous transluminal coronary angioplasty (PTCA) provides an opportunity to uncover collaterals ready to become functional in case of occlusion of the recipient artery (recruitable collaterals). spontaneously visible on a routine coronary angiogram and with that of recruitable collaterals. MethodsDefinitions. The coronary wedge pressure was defined as the mean distal coronary pressure measured through the central lumen of a balloon catheter during a complete occlusion of the artery for at least 30 sec. It was rounded to the next value divisible by five. The transocclusional pressure gradient was defined as the difference between the mean aortic pressure measured through the guiding catheter at the coronary orifice and the simultaneous coronary wedge pressure. The transstenotic pressure gradient was defined as the difference between the mean pressure distal to the lesion (measured at the tip of the empty balloon catheter situated in the lesion) and the simultaneous mean pressure in the coronary ostium. The degree of stenosis was indicated as a visual estimate of diameter reduction.Only collaterals filling at least a segment of the recipient vessel distal to the lesion were considered. Spontaneously visible collaterals were defined as collaterals documented by routine coronary angiography (performed after sublingual or during intravenous nitroglycerin administration). Recruitable collaterals were defined as collaterals not visible on the routine angiogram but visible during proximal balloon occlusion of the recipient coronary artery. Ipsilateral collaterals connect two vessels with a common coronary ostium, e.g., the left anterior descending coronary artery with the circumflex coronary artery or the right ventricular branch with the posterior descending CIRCULATION 906

Potential protective effect of high coronary wedge pressure on left ventricular function after coronary occlusion.

“…Current angiographic equipment reveals only vessels with luminal diameters of at least 100 gm. Whether 22 We have shown that the coronary wedge pressure not only reflects already visible collaterals but also recruitable collaterals not visible on diagnostic angiograms.22 Furthermore, an increased restenosis rate was reported to be associated with both angiographically well-developed collateral2' and a high coronary wedge pressure. 29 In the present study, we have considered the distal coronary pressure determined during percutaneous balloon revascularization of totally occluded coronary arteries as a functional indicator of collateral circulation.…”

“…The hemodynamics of coronary collaterals have been studied directly in humans during aortocoronary bypass surgery,17 and, more recently, the pressure distally to coronary lesions was measured during percutaneous angioplasty18-22 and the relation of the coronary wedge pressure (pressure in the distal part of the occluded artery) to spontaneously visible and recruitable collaterals has been established. 22 To evaluate the protective role of the coronary collateral circulation, we studied the relation between the mean coronary wedge pressure measured during percutaneous transluminal coronary angioplasty and the left ventricular function in patients with occlusion of a major coronary vessel.…”

High blood pressure is inversely related with the presence and extent of coronary collaterals

“…19 Furthermore, even though the overlap between quantitative measures and qualitative angiographic degrees of collateral flow has been demonstrated to be quite large, 20 quantitative indices of collateral circulation may be better markers of the functional significance of collateral vessels, in particular in recruitable (Rentrop-grade 1) collaterals. 14,21,22 A recent study, 23 nonetheless, reported High blood pressure reduces collaterals J Koerselman et al good correlation between a novel angiographic method of assessment and function. This is to be expected considering the fundamental physical law describing that vessel radius is related to the fourth power of flow.…”

Coronary collaterals during single‐vessel coronary angioplasty: Effects of nitroglycerin

“…The ipsilateral contribution to collateral flow has been reported to range from 17% (our study) to 53%. 9 Presence of collaterals prevented chest pains and ST-segment changes during PTCA compared with patients without collaterals, as spontaneously visible collaterals are more effective than recruitable collaterals. In humans, the effect of nitroglycerin on collateral function has mainly been assessed by means of scintigrams.…”

“…Meier et al 9 found spontaneously visible collaterals to be four times as frequent as recruitable collaterals when they considered collateral filling ≥ grade 2 (Rentrop classification). In contrast, Piek et al 10 found recruitable collaterals to be four times as frequent as spontaneously visible collaterals when using the same criteria of collateralization.…”