Direct Intracoronary Evidence of Collateral Steal in Humans

Seiler, Christian; Fleisch, Martin; Meier, Bernhard

doi:10.1161/01.cir.96.12.4261

Cited by 73 publications

(39 citation statements)

References 29 publications

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“…Another study assessed Doppler coronary flow velocity during intracoronary adenosine injection into the collateral-dependent artery; coronary steal occurred in 10% of patients. 24 We observed a higher frequency of steal, which could be partly attributable to the fact that we applied adenosine systemically whereas it was injected locally into the collateral donor or recipient artery in previous studies. 14,24 Another issue that limits the comparability with previous studies is that coronary steal was not always defined as a reduction of flow velocity 14,24 but as a drop of a pressurederived collateral flow index.…”

Section: Discussion Previous Studies On the Effect Of Adenosine On Comentioning

confidence: 66%

“…24 We observed a higher frequency of steal, which could be partly attributable to the fact that we applied adenosine systemically whereas it was injected locally into the collateral donor or recipient artery in previous studies. 14,24 Another issue that limits the comparability with previous studies is that coronary steal was not always defined as a reduction of flow velocity 14,24 but as a drop of a pressurederived collateral flow index. 16 But because steal represents a reduction of flow, and distal coronary pressure (P D ) may decrease even when flow increases during adenosine infusion (Figure 4), coronary steal should be defined by parameters of flow and not pressure.…”

Section: Discussion Previous Studies On the Effect Of Adenosine On Comentioning

confidence: 66%

“…All 3 assumptions are supported by our data. First, coronary steal required well-developed collaterals, 14,16,24 whereas collaterals in group N had a lower CFI, higher R CP , and predominantly a systolic collateral flow pattern, as evidence of reduced collateral function. 18,26 As shown previously, collateral resistance is not negligible.…”

Section: Direct Confirmation Of the Collateral Network Model In Manmentioning

confidence: 99%

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

Werner

Figulla

2002

Circulation

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Background-Coronary steal can occur in collateral-dependent myocardium during pharmacologically induced vasodilation. This study assessed coronary steal invasively in chronic total coronary occlusions (TCOs). Methods and Results-In 35 consecutive patients with a percutaneous transluminal coronary angioplasty of a TCO (duration Ͼ4 weeks), coronary flow velocity (APV) by a Doppler wire and distal pressure (P D ) by a pressure wire were assessed in the collateral-dependent vascular bed before dilatation. Indexes of peripheral resistance (R P ) and for the collateral pathway, including the donor artery segment (R CP ), were calculated. Changes of these parameters were assessed during intravenous adenosine (140 g · kg Ϫ1 · min Ϫ1 ). Adenosine caused a decrease of APV, ie, coronary steal, in 13 patients (37%; group S), an increase in 11 patients (group R), and no change in 11 patients (group N). Angiographic analysis of collateral pathways showed no difference between the groups, except that in group S all collateral connections were continuously visible but no large collaterals (Ͼ0.5 mm) were found. In group N, collaterals were least developed. The increase of APV in group R was associated with a decrease of R P , whereas R CP remained unchanged. In contrast, group S showed no change in R P but a significant increase of R CP , indicating an increased resistance of the donor segment. Conclusions-Coronary

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Section: Discussion Previous Studies On the Effect Of Adenosine On Comentioning

confidence: 66%

Section: Discussion Previous Studies On the Effect Of Adenosine On Comentioning

confidence: 66%

Section: Direct Confirmation Of the Collateral Network Model In Manmentioning

confidence: 99%

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

Werner

Figulla

2002

Circulation

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“…No myocardial steal phenomenon was observed. This is probably due to the moderate, single-vessel stenosis (70 -80% diameter narrowing) created in this study, as opposed to a critical stenosis with obstructed collaterals, in which case it is generally believed that a coronary steal can occur (42,43).…”

Section: Discussionmentioning

confidence: 74%

Assessment of myocardial oxygen extraction fraction and perfusion reserve with BOLD imaging in a canine model with coronary artery stenosis

Zhang

Gropler

et al. 2007

Magnetic Resonance Imaging

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Purpose:To determine the feasibility of T 2 -weighted BOLD imaging for estimating regional myocardial oxygen extraction fraction (OEF) and approximating perfusion reserve (MPR) simultaneously in a canine model with moderate coronary artery stenosis. Materials and Methods:Eight mongrel dogs with moderate coronary artery stenosis underwent BOLD imaging at rest and during dipyridamole-induced hyperemia, using a turbo spin echo (TSE) sequence. Based on a two-compartment model, myocardial OEF hyperemia was calculated with the corresponding T 2 . MPR could be approximated based on Fick's law. Results:During responsive hyperemia, a regional hypointensity was observed in the abnormally perfused myocardium, reflecting a relatively smaller myocardial T 2 increase (3.06% Ϯ 2.74%, in contrast to 10.19% Ϯ 4.12% in the normal region). The average OEFs in the normally and abnormally perfused myocardial territories were 0.21 Ϯ 0.11 and 0.43 Ϯ 0.12, respectively. For the MPR approximated from the BOLD imaging, a strong correlation (R ϭ 0.9) in the normal myocardium and a good correlation (R ϭ 0.6) distal to the stenosis were obtained compared to microsphere results. Conclusion:In a canine model with moderate coronary artery stenosis, TSE-based BOLD imaging can quantitatively estimate the regional OEF hyperemia and approximate the MPR, and can distinguish segments perfused by defected coronary artery. CORONARY ARTERY DISEASE (CAD) manifests as an imbalance between myocardial oxygen supply and demand. The myocardial oxygen extraction fraction (OEF) and myocardial perfusion reserve (MPR, the ratio of peak myocardial blood flow to the baseline) are two important physiological indices of CAD and can provide early information for detecting ischemic heart disease. First-pass magnetic resonance imaging (MRI) can quantify MPR by bolus-tracking kinetics of the injected contrast agent (1-3) with a relatively high signal-tonoise ratio (SNR) and high sensitivity (4). However, this approach cannot provide information about the myocardial oxygenation, and requires at least two contrastagent injections to measure the myocardial blood flow at rest and during pharmacologic stress. Alternatively, MR blood oxygen level-dependent (BOLD) imaging may serve as a non-contrast-agent approach to determine myocardial oxygenation (5-7) and to estimate MPR at the same time (8). Briefly speaking, alterations of oxygen content in the capillaries and venous vessels result in different signal intensities in T* 2 -or T 2 -weighted MRI (known as the BOLD effect) because of the local magnetic field inhomogeneities in and around the vessel caused by paramagnetic deoxyhemoglobin in the vessels. Though T* 2 -weighted imaging has a larger signal response to changes in blood oxygenation than T 2 -weighted imaging (9), cardiac motion and the substantial field inhomogeneity between the heart and lung interface may cause artifacts in T* 2 -weighted gradient-echo-based BOLD images (10 -13), inhibiting accurate data interpretation in the myocardium. The T 2 -prepared steady-...

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“…Coronary steal is defined as a fall in blood flow toward a certain vascular region in favor of another area during arteriolar vasodilatation, i.e., a coronary flow velocity reserve (CFVR) of <1 (1)(2)(3). This can be assessed non-invasively by transthoracic Doppler echocardiography.…”

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confidence: 99%

Direct Demonstration of Coronary Steal Phenomenon Assessed by Transthoracic Doppler Echocardiography

2004

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Coronary steal is defined as a fall in blood flow toward a certain vascular region in favor of another area during arteriolar vasodilatation, i.e., a coronary flow velocity reserve (CFVR) of <1(1-3). This can be assessed non-invasively by transthoracic Doppler echocardiography. A 78 year-old woman presented a 2 month history of exertional chest oppression and dyspnea. Her past medical history included an anterior wall myocardial infarction and type 2 diabetes mellitus. Coronary angiography showed total occlusion of the proximal part of the left anterior descending coronary artery (LAD) and the right coronary artery. The distal part of the LAD was filled with collaterals from the left circumflex coronary artery ( Figure 1, left panel). Transthoracic Doppler echocardiography showed a diastolic dominant antegrade coronary flow in the distal LAD (Figure 1, right panel) suggesting that collateral input from the circumflex coronary artery was more proximal to the recording site. Coronary flow velocity in the distal LAD during intravenous adenosine infusion (140 g/kg/min) gradually decreased and exhibited retrograde flow in a beat to beat basis (Figure 2, A to E). These findings directly demonstrate coronary steal during pharmacologic vasodilation on collateral-dependent coronary flow distal to the occlusion by transthoracic Doppler echocardiography. In addition to the decrease in the antegrade flow velocity (CFVR < 1), retrograde flow velocity profiles during a short period of several cardiac cycles could be detected that correspond to "steal" in the true sense of the word [4]. The mechanism for this change of flow velocity direction might be a fall in perfusion pressure at the origin of collateral vessels [3]. Because recent studies demonstrated a pressure drop during hyperemia in angiographically normal segments of patients with coronary artery disease attributable to diffuse atherosclerosis [5], the slight change of coronary flow velocity in the donor artery during adenosine infusion would produce a considerable difference of pressure drop in a beat to beat basis. This could affect the absolute flow velocity as well as the flow direction. Transthoracic Doppler echocardiography is a useful non-invasive method for detecting coronary steal in humans.

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Direct Intracoronary Evidence of Collateral Steal in Humans

Cited by 73 publications

References 29 publications

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

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

Assessment of myocardial oxygen extraction fraction and perfusion reserve with BOLD imaging in a canine model with coronary artery stenosis

Direct Demonstration of Coronary Steal Phenomenon Assessed by Transthoracic Doppler Echocardiography

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