Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability?
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ORIGINAL PAPER
Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability? Maja Pirnat1 · Arthur E. Stillman4 · Rainer Rienmueller3 · Marko Noc2 · Mario Gorenjak5 · Tomaž Šeruga6 Received: 14 February 2020 / Accepted: 28 August 2020 © Springer Nature B.V. 2020
Abstract The success rate of percutaneous coronary artery intervention (PCI) of chronic total occlusion (CTO) lesions have increased in the recent years. However, improvement of function is only possible when significant myocardial viability is present. One of the most important factors of maintaining myocardial viability is the opening and development of collaterals. Our hypothesis was that with a higher degree of collaterals more viable myocardium is present. In 38 patients we compared the degree of collaterals, evaluated with a conventional coronary angiogram (CCA) and graded by the Rentrop classification to transmural extent of the scar obtained in a viability study with magnetic resonance (MRI). We found a statistically significant association of the degree of collaterals determined with Rentrop method and transmural extent of the scar as measured by CMR (p = 0.001; Tau = -0.144). Additionally, associations showed an increase in the ratio between viable vs. non-viable myocardium with the degree of collaterals. Our study suggests that it may be beneficial to routinely grade the collaterals at angiography in patients with CTO as an assessment of myocardial viability. Keywords Myocardial viability · Collateral grade · CMR · CCA · Rentrop method · Viability parameters
Introduction During the last decade, techniques for percutaneous coronary artery intervention (PCI) of chronic total occlusion (CTO) have developed significantly, leading to the success rate of 85–90% in hands of dedicated operators [1]. Although PCI of CTO does not reduce major adverse cardiovascular events (MACE), there may be significant improvement in * Maja Pirnat [email protected] 1
Radiology Department, University Medical Centre Maribor, Maribor, Slovenia
2
Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
3
Medical University Graz, Graz, Austria
4
Department of Radiology and Imaging Sciences Cardiothoracic Imaging, Emory Universitiy School of Medicine, Atlanta, USA
5
Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
6
Radiology Department, University Clinical Center, Maribor, Slovenia
the quality in life [2]. However, such benefits of PCI CTO are likely only if significant myocardial viability is present in the CTO territory. The evaluation of myocardial viability before PCI is therefore of interest. Various factors may modify the natural course and size of myocardial infarction in the acute stage: duration of ischemia, size, and location of occlusion, coronary cardioprotective medication and coronary artery anatomy [3]. The extent and duration of reduced or total stoppage of blood flo
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