Quantitatively assessed coronary collateral circulation and restenosis following percutaneous revascularization

Aims A high degree of collateral supply to a vascular area where a percutan eous transluminal coronary angioplasty (PTCA) has been performed represents a haemodynamic force competing with the antegrade flow through the dilated lesion. Therefore, our purpose was to determine whether patients with rest enosis following PTCA have a higher collateral flow to the recipient vessel than patients without restenosis. Methods and Results In 200 consecutive PTCA patients, an intracoronary pres sure-derived collateral Row index (CFI) was determined quantitatively durin g balloon occlusion, using simultaneous measurements of the mean aortic pre ssure (P-ao) and of the intracoronary pressure distal to the occluded steno sis (P-occl), as well as the estimated central venous pressure (CVP=5 mmHg) : CFI=(P-occl-CVP)/(P-ao-CVP). Sixty-four patients had an angiographic foll ow-up examination after at least 2 months, and were subdivided into patient s with restenosis (>50% diameter stenosis, n=34) and patients without reste nosis (n=30). Patients with restenosis had a significantly higher collatera l how index at the initial coronary angiography than patients without reste nosis (0.26 +/- 0.14 vs 0.12 +/- 0.09: P<0.0001). Conclusions Patients with restenosis after PTCA show a more extended collat eral supply to this recipient area than patients without restenosis. Well d eveloped collaterals to a revascularized region are a risk factor for reste nosis of the treated lesion. (Eur Heart J 2000; 21: 1776-1784, doi:10.1053/ euhj.2000. 2129) (C) 2000 The European Society of Cardiology.