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Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study
  1. D Perera1,
  2. P Postema1,
  3. R Rashid1,
  4. S Patel1,
  5. L Blows1,
  6. M Marber1,
  7. S Redwood1
  1. Cardiovascular Division, Rayne Institute, St Thomas’ Hospital Campus, King’s College London, UK
  1. Correspondence to:
    Dr Simon Redwood
    Department of Cardiology, St Thomas’ Hospital, London SE1 7EH, UK; Simon.Redwood{at}gstt.nhs.uk

Abstract

Objective: To evaluate whether a well developed collateral circulation predisposes to restenosis after percutaneous coronary intervention (PCI).

Design: Prospective observational study.

Patients and setting: 58 patients undergoing elective single vessel PCI in a tertiary referral interventional cardiac unit in the UK.

Methods: Collateral flow index (CFI) was calculated as (Pw − Pv)/(Pa − Pv), where Pa, Pw, and Pv are aortic, coronary wedge, and right atrial pressures during maximum hyperaemia. Collateral supply was considered poor (CFI < 0.25) or good (CFI ⩾ 0.25).

Main outcome measures: In-stent restenosis six months after PCI, classified as neointimal volume ⩾ 25% stent volume on intravascular ultrasound (IVUS), or minimum lumen area ⩽ 50% stent area on IVUS, or minimum lumen diameter ⩽ 50% reference vessel diameter on quantitative coronary angiography.

Results: Patients with good collaterals had more severe coronary stenoses at baseline (90 (11)% v 75 (16)%, p < 0.001). Restenosis rates were similar in poor and good collateral groups (35% v 43%, p  =  0.76 for diameter restenosis, 27% v 45%, p  =  0.34 for area restenosis, and 23% v 24%, p  =  0.84 for volumetric restenosis). CFI was not correlated with diameter, area, or volumetric restenosis (r2 < 0.1 for each). By multivariate analysis, stent diameter, stent length, > 10% residual stenosis, and smoking history were predictive of restenosis.

Conclusion: A well developed collateral circulation does not predict an increased risk of restenosis after PCI.

  • CFI, collateral flow index
  • CTO, chronic total coronary occlusion
  • IVUS, intravascular ultrasound
  • MLA, minimum lumen area
  • MLD, minimum lumen diameter
  • Pa, aortic pressure
  • PCI, percutaneous coronary intervention
  • Pv, right atrial pressure
  • Pw, coronary wedge pressure
  • QCA, quantitative coronary angiography
  • TIMI, thrombolysis in myocardial infarction
  • TVR, target vessel revascularisation
  • collateral flow index
  • intravascular ultrasound
  • restenosis
  • percutaneous coronary intervention

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Footnotes

  • Published Online First 10 October 2005

  • Competing interests: None declared

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