Angiographic Assessment of Collateral Connections in Comparison With Invasively Determined Collateral Function in Chronic Coronary Occlusions

Abstract

Background-The evaluation of new therapeutic modalities to induce collateral growth in coronary artery disease require improved methods of angiographic characterization of collaterals, which should be validated by quantitative assessment of collateral function. Methods and Results-In 100 patients with total chronic occlusion of a major coronary artery (duration Ͼ2 weeks) collaterals were assessed angiographically by the Rentrop grading, by their anatomic location, and by a new grading of collateral connections (CC grade 0: no continuous connection, CC1: threadlike continuous connection, CC2: side branch-like connection). The interobserver variability was 10%. Collateral function was assessed by Doppler flow (average peak velocity) and pressure recordings distal to the occlusion before recanalization. A collateral resistance index (R Coll ) was calculated. Recruitable collateral flow was measured during a final balloon inflation Ͼ30 minutes after the baseline measurement. The comparison of the anatomic location, the Rentrop, and the collateral connection grade showed only for the latter an independent and significant relation with R Coll . CC2 collaterals preserved regional left ventricular function better than did CC1 collaterals and provided a higher collateral flow reserve during adenosine infusion. CC0 collaterals were predominantly observed in recent occlusions of 2 to 4 weeks' duration, with the highest R Coll . During balloon reocclusion, recruitable collateral function was best preserved with CC2 and least with CC0. Conclusions-The angiographic grading of collateral connections in total chronic occlusions could differentiate collaterals according to their functional capacity to preserve regional left ventricular function and was closely associated with invasively determined parameters of collateral hemodynamics.

Regression of Collateral Function After Recanalization of Chronic Total Coronary Occlusions

“…19, 20 The present study should assess whether collaterals regress or remain preserved several months after recanalization. Possible clinical determinants of collateral regression could be diabetes mellitus, 21 the regional left ventricular (LV) function and prior MI 19 or angiographic factors such as collateral anatomy and size, 22 and the incidence of restenosis or reocclusion.…”

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

“…+ Indicates present; −, absent; BMI, body mass index; CABG, coronary artery bypass grafting; CL, ; CTO, chronic total occlusion; J‐CTO, Japan Chronic Total Occlusion score; LAD, left anterior descending artery; LCX, circumflex artery; ORA, ostial location, Rentrop grade <2, age ≥75 years; PCI, percutaneous coronary intervention; PROGRESS‐CTO, Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; and RECHARGE, Registry of Crossboss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom.aModerate tortuosity was defined as 2 bends >70° or 1 bend >90° proximal to the lesion.bApplying specific collateral classification scoring (range, 0–2) combining Werner collateral classification,40 tortuosity, and collateral type (septal, epicardial, or other).…”

“…Applying specific collateral classification scoring (range, 0–2) combining Werner collateral classification,40 tortuosity, and collateral type (septal, epicardial, or other).…”

Prognostic Significance of Coronary Collaterals in Patients With Coronary Heart Disease Having Percutaneous Transluminal Coronary Angioplasty

“…It is likely that in these relatively low-risk patients, the presence of well-developed collaterals marks sufficient collateral blood flow to adequately counterbalance the adverse effects of CHD. 12 However, particularly in relatively high-risk patients, the presence of barely developed coronary collaterals (Rentrop grade 1) may indicate such limited collateral function that it does not compensate for the disease severity, thus putting the patient at an even greater risk. In relatively high-risk patients, the presence of well-developed collaterals may also mark better myocardial perfusion, but the more adverse affects of ischemic heart disease tend to prevail.…”