Rapid Decline of Collateral Circulation Increases Susceptibility to Myocardial Ischemia
The Trade-Off of Successful Percutaneous Recanalization of Chronic Total Occlusions
Marco Zimarino, MD, PhD,
Arturo Ausiello, MD,
Gaetano Contegiacomo, MD,
Irene Riccardi, MD,
Giulia Renda, MD, PhD,
Cesare Di Iorio, MD and
Raffaele De Caterina, MD, PhD*
Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
View larger version (20K):
[in a new window]
|
Figure 1 Flow chart of study protocol. Chest pain = chest pain score; DES = drug-eluting stent; ECG = electrocardiogram; Pa = mean aortic pressure; Pd = coronary distal pressure; Pw = coronary wedge pressure; QCA = quantitative coronary angiography; Rentrop = angiographic grading of collateral circulation; TIMI = Thrombolysis In Myocardial Infarction flow grade;  ST = sum of ST-segment elevation in all 12 leads as compared with baseline.
|
|
View larger version (9K):
[in a new window]
|
Figure 2 Modifications of fractional flow reserve (FFR) parameters: fractional flow reserve myocardial (FFRmyo), fractional flow coronary reserve (FFRcor), and fractional flow reserve collateral (FFRcoll). Measurements were performed before (baseline), after the first balloon inflation (Post 1), after the second balloon inflation (Post 2), and after drug-eluting stent deployment (Final). Data are mean ± SD; p < 0.008 for each parameter versus the previous time point.
|
|
View larger version (88K):
[in a new window]
|
Figure 3 Angiographic findings, electrocardiographic and pressure measurements during recanalization of a chronic right coronary artery occlusion (black asterisk), with collateral circulation (white arrows) supported from the left coronary system at baseline. Measurements of mean aortic pressure (Pa) and coronary wedge pressure (Pw) documented a collateral pressure index (CPI) (collateral pressure index = Pw/Pa) of 0.61 during the first balloon inflation (Balloon 1). After the first balloon inflation (Post 1), the percentage diameter stenosis was 65% (white arrowhead). During the second balloon inflation (Balloon 2), CPI decreased to 0.46, and a slight ST-segment modification (black arrow) was evident on the electrocardiogram. A residual diameter stenosis of 42% (double white arrowheads) was documented by angiography (Post 2). During the drug-eluting stent (DES) deployment, collateral pressure index dropped to 0.33, the patient experienced chest pain (grade 4/10), and a marked ST-segment elevation (double black arrows) was evident on the electrocardiogram. Angiography showed an 8% residual diameter stenosis (Final).
|
|
|
