(Circulation. 1997;96:4261-4267.)
© 1997 American Heart Association, Inc.
Articles |
Direct Intracoronary Evidence of Collateral Steal in Humans
From Cardiology, University Hospital, Bern, Switzerland.
Correspondence to PD Dr Christian Seiler, MD, FESC, University Hospital, Cardiology, Inselspital, Freiburgstr, Bern, Switzerland. E-mail christian.seiler{at}insel.ch
Background Coronary steal is defined as a fall in blood flow toward a certain vascular region in favor of another area during arteriolar vasodilatation, ie, a coronary flow velocity reserve (CFVR) <1. The purpose of this study was to determine the frequency of steal in patients with a wide range of collateral supply to a vascular area of interest and to assess whether steal is associated with the amount of collateral flow.
Methods and Results One hundred patients 57±9 years old with a coronary artery stenosis to be dilated were examined with intracoronary (IC) Doppler guidewires. IC adenosine–induced CFVR<1 obtained distal to the stenosis was defined as steal. An index for collateral flow was determined by positioning the Doppler guidewire in the collateral-dependent vessel distal to the stenosis and measuring the flow velocity time integral during (Vioccl, cm) and after (Viø-occl) balloon occlusion. Vioccl/Viø-occl was determined without and with intravenous adenosine (140 µg · kg-1 · min-1). Coronary steal occurred in 10 of 100 patients. Patients with steal showed superior collaterals compared with those without steal: Vioccl/Viø-occl=0.65±0.24 in patients with steal versus 0.29±0.18 in those without steal (P=.0001). In all patients with steal, there was a reduction in collateral flow during intravenous adenosine–induced hyperemia, whereas in the majority (70%) of patients without steal, collateral flow increased or remained unchanged during hyperemia.
Conclusions Coronary steal assessed by intracoronary Doppler flow velocity measurements occurs in 10% of patients with a wide range of coronary collaterals to the vascular area from which blood flow is redistributed. There is a direct association between the presence of steal away from and the amount of collateral flow toward the region under investigation. Collateral flow to the vascular region studied decreases during adenosine-induced hyperemia, which indicates a mechanism of steal via the extensive collaterals.
Key Words: coronary disease • collateral circulation • regional blood flow • steal • adenosine
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