Spectral analysis of flow velocity in the contralateral artery during coronary angioplasty: A new method for assessing collateral flow

Piek, Jan J.; Koolen, Jacques; Rijn, A. C. Metting van; Bot, Hans; Hoedemaker, G.; David, George K.; Dunning, Arend J.; Spaan, Jos A. E.; Visser, Cees A.

doi:10.1016/0735-1097(93)90371-7

Cited by 39 publications

(15 citation statements)

References 25 publications

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“…Clinically, well-developed epicardial collateral vessels are detectable by angiography and injection of contrast in the contralateral collateral vessel, especially during occlusion of the collateral-dependent artery (19). However, this detection method does not apply to detection of small intramural collateral vessels, although angiography may reveal functional small collaterals by a blush of contrast in the collateral-dependent region.…”

Section: Discussionmentioning

confidence: 99%

Porcine coronary collateral formation in the absence of a pressure gradient remote of the ischemic border zone

Wijngaard

Schulten

Horssen

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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van den Wijngaard JP, Schulten H, van Horssen P, ter Wee RD, Siebes M, Post MJ, Spaan JA. Porcine coronary collateral formation in the absence of a pressure gradient remote of the ischemic border zone. Am J Physiol Heart Circ Physiol 300: H1930 -H1937, 2011. First published March 11, 2011 doi:10.1152/ajpheart.00403.2010.-In the current paradigm on coronary collateral development, it is assumed that these vessels develop consequentially from increased fluid shear stress (FSS) through preexisting collateral arteries. The increased FSS follows from an increase in pressure gradient between the region at risk and well-perfused surroundings. The objective of this study was to test the hypothesis that, in the heart, collateral connections can form in the absence of an increased FFS and consequentially at any depth and region within the ventricular wall. In Yorkshire pigs, gradual left circumflex coronary artery occlusion was obtained over 6 wk by an ameroid constrictor, whereas the control group underwent a sham operation. Hearts were harvested and subsequently processed in an imaging cryomicrotome, resulting in 40-m voxel resolution threedimensional reconstructions of the intramural vascular vessels. Dedicated software segmented the intramural vessels and all continuous vascular pathways containing a collateral connection. In the ameroid group, 192 collaterals, 22-1,049 m in diameter, were detected with 62% within the subendocardium. Sixty percent of collaterals bridged from the left anterior descending artery to left circumflex coronary artery. A novel result is that 25% (n ϭ 48) of smaller-radius collaterals (P ϭ 0.047) connected with both origin and terminus in the nontarget area where perfusion was assumed uncompromised. In the porcine heart, collateral vessels develop not only in ischemic border zones with increased FSS but also away from such border zones where increased FSS is unlikely. The majority of collaterals were located at the subendocardium, corresponding to the region with highest prevalence for ischemia. imaging cryomicrotome; collaterals; ischemia; remodeling; fluid shear stress STIMULATING CORONARY COLLATERAL formation by neovascularization may serve as a last therapeutic resort for patients that cannot be successfully revascularized by coronary artery bypass surgery or percutaneous coronary intervention. However, further development of this therapeutic modality requires more detailed information on the mechanisms of collateral formation.There are differences of opinion whether in the porcine heart collaterals grow de novo, i.e., through angiogenesis stimulated by ischemia, or from innate nonfunctional collaterals that are already present, i.e., arteriogenesis stimulated by shear stress (23,29). In the hindlimb occlusion model, collaterals growing in the nonischemic area proximal to the experimentally induced flow obstruction clearly indicates the role of increased fluid shear stress (FSS) in outward remodeling (7, 9, 23). In the heart, however, regions of ischemia are intertwined with areas of inc...

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Section: Discussionmentioning

confidence: 99%

Porcine coronary collateral formation in the absence of a pressure gradient remote of the ischemic border zone

Wijngaard

Schulten

Horssen

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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“…7,10,12,13 However, this level of CFI does not protect from exercise ischemia and can lead to regional myocardial dysfunction even in the absence of infarction. 11 Most of the patients with TCOs had a history of infarction despite a high CFI, which indicates that the collaterals were not yet fully developed at the time of infarction.…”

Section: Werner Et Al Collateral Circulation In Chronic Tcos 2963mentioning

confidence: 99%

“…Many studies were carried out during PTCA of nonocclusive coronary lesions as a model of ischemia. 7,[12][13][14] Some studies on the function of collaterals included patients with TCOs, but no distinction was made between nonocclusive and occlusive lesions. [15][16][17][18][19][20] Because the recurrence of TCOs after PTCA often leads to clinical symptoms, including myocardial infarction, 4,5,[21][22][23] we assumed that the collateral function in TCO would change after reopening of the artery.…”

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confidence: 99%

Immediate Changes of Collateral Function After Successful Recanalization of Chronic Total Coronary Occlusions

et al. 2000

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Background-Coronary collaterals are essential to maintain myocardial function in chronic total coronary occlusions (TCOs). The aim of the present study was to assess the collateral circulation in TCOs before coronary angioplasty and to determine the recruitable collateral perfusion after recanalization by use of intracoronary Doppler flow velocimetry. Methods and Results-In 21 patients with TCOs (duration Ͼ4 weeks), Doppler recordings of basal collateral flow were obtained before the first balloon inflation. Angioplasty was performed with stent implantation in all lesions. At the end of the procedure, recruitable collateral flow was measured during a repeat balloon inflation. The collateral flow index (CFI) was calculated from the velocity integral during the occlusion/velocity integral of antegrade flow. In 17 of 21 patients, angiography was repeated after 24 hours, and CFI was reassessed. Average peak velocity of collateral flow was 10.9Ϯ5.6 cm/s with a predominantly systolic flow (diastolic/systolic velocity ratio Ͻ0.5) compared with antegrade flow (diastolic/systolic velocity ratio Ͼ1.5). After recanalization, the average peak velocity of recruitable collateral flow dropped by Ͼ50% to 4.7Ϯ2.5 cm/s. CFI fell from 0.48Ϯ0.25 to 0.21Ϯ0.16 (PϽ0.001). There was no further change of CFI during the following 24 hours. CFI was higher in patients with preserved regional ventricular function than in those with akinetic myocardium (0.57Ϯ0.23 versus 0.38Ϯ0.12, PϽ0.05). Conclusions-Collateral

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“…The importance and protective role of collateral circulation has been appreciated both experimentally, as well as in the clinical settings [16][17][18][19][20]. Its clinical usefulness, however, has been limited probably because of two reasons: [1] no reliable quantitative method for evaluation of collateral circulation was available, and [2] clinical focus on treatment of coronary stenosis, with exponential rise and clinical interest in angioplasty over evaluation of coronary physiology.…”

Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of collateral circulation in patients with previous myocardial infarction: relation to myocardial ischemia, angiographic appearance and functional improvement of myocardium

Vukčević

Beleslin

Ostojić

et al. 2009

Int J Cardiovasc Imaging

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Evaluation of coronary pressures during angioplasty may functionally quantify collateral circulation. The aim of the study was to evaluate the relation between the amount of collateral circulation and development of myocardial ischemia during balloon occlusion, anatomic degree of collaterals, and functional improvement of myocardium. Study population consisted of 31 pts (mean age 53 +/- 7 years; 25 male) with previous myocardial infarction and significant one-vessel stenosis undergoing angioplasty. Collateral circulation was calculated as the ratio between distal coronary pressure during balloon occlusion (P(w)) and aortic pressure (P(a)). Angiographic appearance of collaterals was evaluated by Rentrop classification. Patients were evaluated by echo for functional improvement of myocardium in the follow-up period. Mean P(w)/P(a) was 0.24 +/- 0.10 (range of 0.07-0.51). Rentrop grade 0 of collaterals was present in 16 patients (52%), grade 1 in11 patients (35%), and grade 2 in 4 patients (13%). A mild correlation between angio and hemodynamic evaluation of collaterals was observed (r = 0.38, P = 0.035). In patients without ECG changes during angioplasty (21 pts, 68%), P(w)/P(a) was significantly higher in comparison to patients with ECG changes (0.28 +/- 0.09 vs. 0.15 +/- 0.06, P < 0.001; area under the curve 0.93). In patients with myocardial functional improvement during follow-up (21 pts, 68%), P(w)/P(a) was significantly higher than in the patients without echo improvement (0.26 +/- 0.10 vs. 0.18 +/- 0.08, P = 0.035). The amount of recruitable collaterals is not negligible even in the patients with no angio visible collaterals. Low values of P(w)/P(a) are associated with ECG changes during balloon occlusion. Higher P(w)/P(a) was associated with better functional improvement of myocardium.

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Spectral analysis of flow velocity in the contralateral artery during coronary angioplasty: A new method for assessing collateral flow

Cited by 39 publications

References 25 publications

Porcine coronary collateral formation in the absence of a pressure gradient remote of the ischemic border zone

Porcine coronary collateral formation in the absence of a pressure gradient remote of the ischemic border zone

Immediate Changes of Collateral Function After Successful Recanalization of Chronic Total Coronary Occlusions

Quantitative evaluation of collateral circulation in patients with previous myocardial infarction: relation to myocardial ischemia, angiographic appearance and functional improvement of myocardium

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