Direct Assessment of Coronary Steal and Associated Changes of Collateral Hemodynamics in Chronic Total Coronary Occlusions

Werner, Gerald S.; Figulla, Hans R.

doi:10.1161/01.cir.0000022848.92729.33

Cited by 59 publications

(48 citation statements)

References 48 publications

(50 reference statements)

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“…Our findings are similar to those recently reported by Werner at al 12 by intracoronary Doppler ultrasound, with the difference that they found collateral flow withdrawal mainly in patients with Rentrop grade 2 collaterals rather than grade 1 ( Figure 5). We may therefore suggest that a poorly developed collateral circulation is more prone than a well-developed collateral circulation to withdraw its flow support to the occluded coronary artery under stress.…”

Section: Discussionsupporting

confidence: 92%

“…A possible explanation may be that Werner et al 12 included patients with previous myocardial infarctions of the index artery, whereas Watanabe et al 9 and we studied only patients without previous infarctions of the myocardium distal to the occluded artery. In addition, there may be some pitfalls in the measurement of collateral flow by intracoronary Doppler flow wire: (1) it is technically demanding, (2) the position of the tip of the wire relative to the occlusion and to the input of collateral flow may be suboptimal, (3) sampling too close to the occlusion site may result in small coronary flow velocity recordings, (4) artifacts may be generated by guidewire motion and inadvertent contact with the vessel wall, 13 and (5) placing the Doppler wire requires a previous opening of the vessel with a stiff wire, which creates a new channel, potentially altering collateral flow dynamics.…”

Section: Discussionmentioning

confidence: 90%

“…12,14 However, because collateral flow toward the occluded artery is actually a gift of the "donor" artery, the accusation of theft is unfair, and the term "coronary flow withdrawal" may be more appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…12,14 In our study, we did not measure the resistances but evaluated the degree of the stenosis of the donor coronary artery proximal to the collateral takeoff, which inversely correlated with the CFR (the greater the stenosis, the smaller the CFR). An interesting new finding of our study is that CFR proportionally increased with the number of diseased vessels, suggesting a chronic stimulus to create more connections within the myocardium in case of diffuse atherosclerotic narrowing of the epicardial coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

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Functional Assessment of the Collateral-Dependent Circulation in Chronic Total Coronary Occlusion Using Transthoracic Doppler Ultrasound and Venous Adenosine Infusion

Pizzuto¹,

Voci²,

Puddu³

et al. 2006

The American Journal of Cardiology

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The measurement of collateral flow reserve (CFR; the hyperemic/baseline collateral flow velocity ratio) in patients with chronic total coronary occlusion requires invasive and expensive techniques. Noninvasive transthoracic coronary Doppler echocardiography may be an alternative option. Fifty-one patients with chronic total coronary occlusion were evaluated by transthoracic coronary Doppler echocardiography and venous adenosine infusion to measure CFR in occluded coronary arteries (the left anterior descending artery in 44 patients and the artery supplying the posterior descending artery in 7 patients). CFR data were plotted against 3 angiographic parameters: (1) grade of the epicardial filling of the occluded artery (1 ‫؍‬ absent, 2 ‫؍‬ partial, 3 ‫؍‬ complete), (2) stenosis of the donor artery, and ( Recently, transthoracic coronary Doppler echocardiography (TDE) has been introduced and validated for the noninvasive prediction of coronary artery disease, 1-4 the assessment of coronary recanalization in acute myocardial infarction, 5 and the evaluation of therapeutic coronary interventions. 6 -8 TDE can also predict left anterior descending (LAD) coronary occlusion on the basis of reversed flow in the epicardial artery 9 and in its perforating branches. 10 We undertook this study to (1) assess the feasibility of TDE to noninvasively measure coronary flow reserve of the collateral-dependent circulation distal to the occluding lesion and (2) determine the relation of collateral flow reserve (CFR) to the angiographic collateral anatomy and flow. MethodsStudy population: We enrolled 56 consecutive patients (46 men, 10 women, mean age 59 Ϯ 9 years, range 43 to 75) with chronic total occlusion of the LAD (44 patients) and of the artery supplying the posterior descending coronary artery (PD; 12 patients). Inclusion criteria were (1) Thrombolysis In Myocardial Infarction anterograde coronary flow grade 0, (2) normal global and regional left ventricular function at rest (wall motion score index ϭ 1), and (3) the absence of Q-wave myocardial infarction. Patients with contraindications to adenosine administration were excluded. All patients were in sinus rhythm and fasting state and provided written informed consent. All coronary active medications were withdrawn the day before the Doppler study. Figure 1 shows the clinical model that we used: occluded coronary artery (either the LAD or the artery supplying the PD), visible collaterals toward the occluded artery, and good left ventricular function.TDE: TDE was performed as previously described in a modified 2-chamber view, 4,6 using Sequoia C256 and C512 ultrasound systems (Siemens-Acuson, Mountain View, California). The LAD was scanned by a dedicated 7-MHz transducer (3.5 MHz in color Doppler ultrasound) along the anterior interventricular groove, 6 and the PD was scanned using a standard 3.5-MHz transducer (2 MHz in color Doppler ultrasound). 4 The best long-axis view in color Doppler imaging was obtained to optimize the angle be-

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Functional Assessment of the Collateral-Dependent Circulation in Chronic Total Coronary Occlusion Using Transthoracic Doppler Ultrasound and Venous Adenosine Infusion

Pizzuto¹,

Voci²,

Puddu³

et al. 2006

The American Journal of Cardiology

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show abstract

“…Unlike acute occlusion, chronic total coronary occlusion (CTO) of over 1-month duration leads to the formation of stable collateral coronary pathways (Werner & Figulla, 2002;Braden, 2006;Werner et al, 2006). Recently, feasibility of TTE for the CTO identification of the LAD and RCA has been established.…”

mentioning

confidence: 99%