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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

Billinger, Michael ; Fleisch, Martin ; Eberli, Franz R. ; Meier, Bernhard ; Seiler, Christian

In: Cardiovascular Research, 2001, vol. 49, no. 3, p. 600-608

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    Titre
    • 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
    Auteur
    • Billinger, Michael. University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland
    • Fleisch, Martin. University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland
    • Eberli, Franz R.. University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland
    • Meier, Bernhard. University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland
    • Seiler, Christian. E-mail: christian.seiler.cardio@insel.ch
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:303950
    Summary
    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 CFI≥0.15 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