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CLINICAL STUDIES

Functional significance of recruitable collaterals during temporary coronary occlusion evaluated by ^99mTc-sestamibi single-photon emission computerized tomography

Niels Peter R.ønnow Sand, MD, PhD^*, Michael Rehling, DMSci^*, Jens Peder Bagger, DMSci, Leif Thuesen, DMSci, Christian Flø, MSci^* and Torsten T. Nielsen, DMSci

^* Department of Nuclear Medicine, Aarhus University Hospital, Skejby Sygehus, Denmark
Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Denmark

Manuscript received February 17, 1999; revised manuscript received September 21, 1999, accepted November 10, 1999.

Reprint requests and correspondence: N.P.R. Sand, Department of Nuclear Medicine, Aarhus University Hospital, Skejby Sygehus, DK-8200 Aarhus N, Denmark

OBJECTIVES

The present study evaluated the impact of recruitable collaterals on regional myocardial perfusion measured by ^99mtechnetium (Tc)-sestamibi single-photon emission computerized tomography (SPECT) during temporary coronary occlusion and related these estimates to the coronary wedge pressure and electrocardiographic (ECG) ST-segment changes.

BACKGROUND

Clinical variables (angina and ECG changes) and intracoronary flow and pressure recordings have indicated a protective role of recruitable collaterals on myocardial perfusion during percutaneous transluminal coronary angioplasty (PTCA).

METHODS

Thirty patients (mean age 55 years, SD 9; 20 men) with stable angina pectoris and proximal nonoccluding single-vessel left anterior descending coronary artery (LAD)-stenosis scheduled for PTCA were included. Visualization of recruitable collaterals by ipsilateral and contralateral contrast injection, registration of coronary wedge pressure and injection of ^99mTc-sestamibi during 90-s LAD occlusions were undertaken. A rest perfusion study was performed within four days before PTCA. As an estimate of the severity of regional hypoperfusion during occlusion, an occlusion/rest count ratio was calculated (mean defect pixel count during occlusion divided by mean pixel count in identical regions at rest).

RESULTS

The scintigraphic occlusion/rest count ratio was higher in patients with recruitable collaterals (n = 16), 67 ± 11%, compared to patients without collaterals (n = 14), 60 ± 6% (p < 0.05). The occlusion/rest count ratio correlated with the coronary wedge pressure (R² = 0.34; p < 0.001). The occlusion/rest count ratio was lower, 61 ± 6%, in patients with ST-segment elevation (n = 23) versus 74 ± 9% in patients without ST-segment elevation (n = 7) (p < 0.0001).

CONCLUSIONS

Using ^99mTc-sestamibi SPECT imaging during brief episodes of coronary occlusion, the severity of regional myocardial hypoperfusion was reduced by the presence of recruitable collaterals in a selected patient population with proximal LAD stenoses. Our results demonstrate a protective effect of recruitable collaterals on myocardial perfusion during temporary coronary occlusion.

Abbreviations and Acronyms   AUC = area under the curve   LAD = left anterior descending coronary artery   PTCA = percutaneous transluminal coronary angioplasty   SPECT = single-photon emission computerized tomography   99mTc-sestamibi = 99m-technetium-sestamibi

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