This Article Full Text Full Text (PDF) All Versions of this Article: 115/15/2015    most recent CIRCULATIONAHA.106.665257v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Perera, D. Articles by Redwood, S. R. Search for Related Content PubMed PubMed Citation Articles by Perera, D. Articles by Redwood, S. R. Related Collections Catheter-based coronary interventions: stents Coronary imaging: angiography/ultrasound/Doppler/CC Chronic ischemic heart disease Coronary circulation Other Vascular biology

(Circulation. 2007;115:2015-2021.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Coronary Collaterals Remain Recruitable After Percutaneous Intervention

Divaka Perera, MA, MB, BChir, MD, MRCP; Gajen S. Kanaganayagam, PhD; Mrinal Saha, MA, MBBS, MRCP; Rizwan Rashid, BSc; Michael S. Marber, MBBS, PhD, FRCP; Simon R. Redwood, MBBS, MD, FRCP

From the Cardiovascular Division, Rayne Institute, St Thomas’ Hospital Campus, King’s College, London, UK.

Correspondence to Dr Simon Redwood, Department of Cardiology, St Thomas’ Hospital, London SE1 7EH, UK. E-mail Simon.Redwood{at}gstt.nhs.uk

Received September 16, 2006; accepted February 7, 2007.

Background— Rapid loss of collateral support has been reported after percutaneous coronary intervention (PCI), leaving the myocardium susceptible to subsequent infarction. However, well-developed collaterals have been found in normal hearts, suggesting that collaterals exist even in the absence of an ischemic stimulus. We assessed the plasticity and determinants of collateral supply after PCI.

Methods and Results— Collateral flow index (CFI) was calculated in 60 patients as (P_w–P_v)/(P_a–P_v) by measurement of aortic (P_a), central venous (P_v), and coronary wedge (P_w) pressures. CFI was reassessed during transient balloon occlusion 5 minutes and 24 hours after PCI in the first 29 patients and at 6 months in the subsequent 25 patients. We also evaluated the relationship between collateral supply, lesion characteristics, and circulating hemopoietic cells numbers before and after successful PCI. CFI at baseline was 0.23±0.10, with no change 5 minutes and 1 day later (0.21±0.12, P=0.62; and 0.22±0.11, P=0.96, respectively). At 6 months, CFI was 0.14±0.07 or 63±27% of the baseline value (P<0.001). CFI was proportional to severity of the coronary lesion at baseline (r=0.63, P<0.0001) but not 6 months after PCI (r=–0.04, P=0.87). The number of circulating CD133⁺ and CD34⁺ cells was associated with CFI 6 months after PCI (CD133, r=0.59, P=0.035; CD34, r=0.63, P=0.037).

Conclusions— Coronary collateral flow remains undiminished for at least 24 hours after successful PCI. Functional collateral support subsequently declines but does not regress completely.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				M. Saha, S. R. Redwood, and M. S. Marber Exercise training with ischaemia: is warming up the key? Eur. Heart J., July 1, 2007; 28(13): 1543 - 1544. [Full Text] [PDF]