© 2001 by European Society of Cardiology
Copyright © 2001, European Society of Cardiology
Collateral and collateral-adjacent hyperemic vascular resistance changes and the ipsilateral coronary flow reserve
Documentation of a mechanism causing coronary steal in patients with coronary artery disease
University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland
* Corresponding author. Tel.: +41-31-632-3693; fax: +41-31-632-4299 christian.seiler.cardio{at}insel.ch
Objectives: The goal of this clinical study was to assess the influence of hyperemic ipsilateral, collateral and contralateral vascular resistance changes on the coronary flow velocity reserve (CFVR) of the collateral-receiving (i.e. ipsilateral) artery, and to test the validity of a model describing the development of collateral steal. Methods: In 20 patients with one- to two-vessel coronary artery disease (CAD) undergoing angioplasty of one stenotic lesion, adenosine induced intracoronary (i.c.) CFVR during vessel patency was measured using a Doppler guidewire. During stenosis occlusion, simultaneous i.c. distal ipsilateral flow velocity and pressure (Poccl, using a pressure guidewire) as well as contralateral flow velocity measurements via a third i.c. wire were performed before and during intravenous adenosine. From those measurements and simultaneous mean aortic pressure (Pao), a collateral flow index (CFI), and the ipsilateral, collateral, and contralateral vascular resistance index (Ripsi, Rcoll, Rcontra) were calculated. The study population was subdivided into groups with CFI<0.15 and with CFI
0.15. Results: The percentage-diameter coronary artery stenosis (%-S) to be dilated was similar in the two groups: 78±10% versus 82±12% (NS). CFVR was not associated with %-S. In the group with CFI0.15 but not with CFI<0.15, CFVR was directly and inversely associated with Rcoll and Rcontra, respectively. Conclusions: A hemodynamic interaction between adjacent vascular territories can be documented in patients with CAD and well developed collaterals among those regions. The CFVR of a collateralized region may, thus, be more dependent on hyperemic vascular resistance changes of the collateral and collateral-supplying area than on the ipsilateral stenosis severity, and may even fall below 1.
KEYWORDS CAD, coronary artery disease; CFI, collateral flow index; CF(V)R, coronary flow (velocity) reserve; CVP, central venous pressure; Pao, mean aortic pressure; Poccl, distal coronary occlusive (wedge) pressure; PTCA, percutaneous transluminal coronary angioplasty; Rcoll, collateral resistance index; Rcontra, contralateral resistance index; Ripis, ipsilateral resistance index; Vioccl, distal velocity time integral during vessel occlusion; Viø-occl, distal velocity time integral during vessel patency
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