Circulation, Vol 75, 906-913, Copyright © 1987 by American Heart Association
B Meier, P Luethy, L Finci, GD Steffenino and W Rutishauser
Coronary angiography demonstrates only collateral arteries that are already
in use (spontaneously visible collaterals). Percutaneous transluminal
coronary angioplasty (PTCA) provides an opportunity to uncover collaterals
ready to become functional in case of occlusion of the recipient artery
(recruitable collaterals). The incidence of recruitable collaterals and
their relation to the distal pressure in the occluded artery (coronary
wedge pressure) during a 30 sec or longer balloon occlusion was assessed in
57 coronary arteries of 49 patients undergoing PTCA for a proximal coronary
stenosis or occlusion. Collateral to 75% of the arteries were present.
Spontaneously visible collaterals were four times as frequent as
recruitable collaterals. Coronary wedge pressure was significantly higher
in arteries with spontaneously visible and recruitable collaterals (41 +/-
12 and 36 +/- 12 mm Hg, respectively) than in arteries without collaterals
(18 +/- 4 mm Hg). A coronary wedge pressure of 30 mm Hg or higher was found
exclusively in the presence of collaterals. Electrocardiographic changes
during balloon occlusion were found more frequently with arteries without
collaterals than with arteries with spontaneously visible or recruitable
collaterals. Chest pain was more frequent in patients without collaterals
or with recruitable collaterals than in those with spontaneously visible
collaterals. Major in-hospital events occurred in three patients with
collaterals, with a salutary influence of the collaterals in two. The
coronary wedge pressure allows prediction of recruitable collaterals. Their
clinical impact remains to be investigated in long-term studies on large
patient populations.
ARTICLES
Coronary wedge pressure in relation to spontaneously visible and recruitable collaterals
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