COMPARISON OF COLLATERAL VASCULAR-RESPONSES IN THE DONOR AND RECIPIENT CORONARY-ARTERY DURING TRANSIENT CORONARY-OCCLUSION ASSESSED BY INTRACORONARY BLOOD-FLOW VELOCITY ANALYSIS IN PATIENTS

Objectives. This study was designed to evaluate the hemodynamic variab les of the collateral circulation during acute coronary occlusion. Bac kground. There is limited information on the physiology of the collate ral circulation in coronary artery disease, Methods. Angiography of th e contralateral donor artery was performed before and during balloon c oronary occlusion in 57 patients with one-vessel disease, Recruitable collateral how was assessed during coronary occlusion by blood flow an alysis of the contralateral donor artery (n = 19) or the ipsilateral r ecipient artery (n = 15), or both (n = 23), using a Doppler catheter o r guide wire, Ischemia was evaluated by the ST segment shift (greater than or equal to 0.1 mV) on a 12-lead electrocardiogram at 1 min of co ronary occlusion. Results. The presence (n = 39), compared with the ab sence (n = 18), of recruitable collateral vessels was associated with an increase of blood flow velocity in the donor artery (20 +/- 19% vs, 4.8 +/- 5.9% [mean +/- SD], p = 0.003) and the recipient artery (velo city integral 7.2 +/- 5.5 vs, 2.8 +/- 2.2 cm, p = 0.02) related to a r educed relative collateral vascular resistance (9.2 +/- 10 vs, 20 +/- 11, p = 0.003), Collateral flow in the donor artery yielded a similar predictive value for recruitability of collateral vessels as collatera l Bow determined in the recipient artery or the coronary wedge/aortic pressure ratio (areas under the receiver operating characteristics cur ves 0.76 +/- 0.07, 0.78 +/- 0.78 +/- 0.77 +/- 0.07, respectively, p = NS). Collateral how in the recipient artery was a better predictor for ischemia than collateral flow in the donor artery or angiographic gra ding of collateral vessels (areas 0.90 +/- 0.05, 0.64 +/- 0.10, 0.73 /- 0.07, respectively, p < 0.05). Conclusions. Coronary blood flow vel ocity analysis of the donor and recipient coronary arteries can charac terize the dynamics of the collateral circulation during acute coronar y occlusion, The protective effect of recruitable collateral vessels r elates to an increase of flow in the donor and recipient coronary arte ries due to a reduced collateral vascular resistance, This study under scores the importance of physiologic variables for the evaluation of t he function of recruitable collateral vessels. (C) 1997 by the America n College of Cardiology.