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8 The influence of collateral regression post coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on donor vessel coronary pressure-derived measurements
  1. SR Mohdnazri1,2,
  2. F Al-Janabi1,2,
  3. G Karamasis1,2,
  4. J Hampton-Till2,
  5. R Al-Lamee3,
  6. J Dungu1,
  7. S Gedela1,
  8. KH Tang1,
  9. PA Kelly1,
  10. JE Davies3,
  11. R Davies1,2,
  12. TR Keeble1,2
  1. 1The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
  2. 2Anglia Ruskin University Chelmsford, Chelmsford, UK
  3. 3Imperial College London, London, UK


Background There is strong evidence of FFR-guided treatment in multi-vessel disease. The presence of a concomitant CTO may influence the FFR measurement in donor vessel. We sought to investigate the influence of collateral regression after successful CTO recanalisation on donor vessel pressure-derived indices.

Methods 28 out of 34 consecutive patients underwent successful PCI to RCA CTOs and completed the follow up study (at 3 months post CTO-PCI). Resting Pd/Pa,iFR and FFR were measured pre and post successful CTO PCI and at follow-up in donor vessels.

Results The mean resting Pd/Pa, iFR and FFR pre and post-RCA CTO PCI and at follow-up procedures in major donor vessel were (0.893, 0.862, 0.764), (0.907, 0.886, 0.753) and (0.918, 0.901, 0.787) respectively. The mean resting Pd/Pa, iFR and FFR pre and post-RCA CTO PCI and at follow-up procedures in minor donor vessel were (0.979, 0.966, 0.890), (0.983, 0.979, 0.880) and (0.981, 0.974, 0.898) respectively. Changes in pressure-derived indices are summarised in table 1.

Abstract 8 Table 1

Changes in coronary pressure-derived measurements in donor vessel pre and post RCA CTO PCI and at fellow-up (FU: follow-up; PdPa: resting Pd/Pa; PCI: percutaneous coronary intervention; IFR: instantaneous wave-free ratio; FFR: fractional flow reserve; CTO: chronic total occlusion)

Conclusion Successful recanalisation of a RCA CTO results in a significant increase in coronary pressure-derived indices of the major donor vessel at follow-up associated with a regression of collateral function. The expected change and the optimal timing to perform PCI in donor vessel should be considered when planning multi-vessel revascularisation in this setting.

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