The myocardium supplied by a chronic total occlusion is a persistently ischemic zone

Sachdeva, Rajesh; Agrawal, Mayank; Flynn, Shawn E.; Werner, Gerald S.; Uretsky, Barry F.

doi:10.1002/ccd.25001

Cited by 129 publications

(71 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous studies in that area using SPECT or fractional flow reserve (FFR) did not find any relation between these two parameters [9][10][11][12]22]. However, a study with transthoracic coronary Doppler echocardiography with venous adenosine infusion showed that collateral flow reserve correlates well with Rentrop graded collateral flow [23].…”

Section: Discussionmentioning

confidence: 88%

“…The latter hypothesis is based on the observation that stress ischaemia in the CTO territory was found in all patients undergoing FFR, in around 80% of patients undergoing SPECT, and only in around 60% of patients in our study [9][10][11][12]22]. In one small study using CMR, stress perfusion deficits not matching the myocardial scar in patients with CTO were found in 11/16 patients (68%) [24].…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

et al. 2015

View full text Add to dashboard Cite

A b s t r a c tBackground: Indications for revascularisation in chronic total occlusion (CTO) of the coronary artery depend on the interplay between myocardial function, viability, and ischaemia. The technical feasibility of the procedure often relies on the collateral flow to the occluded artery. Aim:To assess the relation between the degree of collateral flow and characteristics of the myocardium supplied by the occluded artery. Methods:The study included 54 patients (mean age 62 years, 85% males) with CTO referred for cardiovascular magnetic resonance (CMR) to assess indications for revascularisation. The presence of well-developed collateral flow was defined as a collateral connection grade = 2 and Rentrop score = 3. Results:The presence of well-developed collaterals (n = 24, 44%) was less likely to be related to systolic dysfunction of the segments supplied by the occluded artery (mean wall motion score index 1.31 ± 0.44 vs. 1.64 ± 0.67, p = 0.04) in comparison to a lack of well-developed collaterals. Patients with well-developed collaterals had a lower frequency of previous myocardial infarction of the CTO territory (38% vs. 67%, p = 0.03) with similar frequency of transmural infarctions (21% vs. 23%, p = 0.83). They less frequently presented perfusion deficits of the CTO area during hyperaemia (42% vs. 70%, p = 0.03) and the size of deficits was smaller (median 0.0% [interquartile range 0-12%] vs. 7.5% [0-15%], p = 0.04). Conclusions:Myocardial segments supplied by CTO with well-developed collaterals are less prone to inducible ischaemia, have better systolic function, and are less likely to undergo myocardial infarction, in comparison to those supplied by CTO with poor collateral circulation. CMR is a non-invasive method that can be used for a comprehensive workup of patients being considered for CTO revascularisation.

show abstract

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 94%

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Elegant studies have shown that virtually all CTOs are ischemic when tested by fractional fl ow reserve, regardless of the maturity of collateral channels (9,10). Most are ischemic at rest, even in the absence of vasodilators and hyperemia.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Tachycardic Storm with a Chronic Total Coronary Artery Occlusion Treated with Percutaneous Coronary Intervention

Mixon¹

2015

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

“…Well‐developed collateral circulation to the CTO target vessel distal to the occlusion has been used as an argument against CTO revascularization, despite studies demonstrating ischemia in nearly all such cases 12, 13. Jang et al10 examined the long‐term outcomes of different treatment strategies among 738 patients with at least one CTO lesion and well‐developed collateral channels.…”

Section: Clinical Benefitsmentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

View full text Add to dashboard Cite

The myocardium supplied by a chronic total occlusion is a persistently ischemic zone

Abstract: In symptomatic patients, a CTO, even with regional left ventricular impairment and/or excellent collateral development, reveals an ischemic zone. This ischemic zone can be normalized by PCI with outcomes appearing to be comparable to non-CTO patients.

Cited by 129 publications

References 23 publications

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

Combined analysis of myocardial function, viability, and stress perfusion in patients with chronic total occlusion in relation to collateral flow

Ventricular Tachycardic Storm with a Chronic Total Coronary Artery Occlusion Treated with Percutaneous Coronary Intervention

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Contact Info

Product

Resources

About