Distal Pressure Measurement beyond Total Coronary Occlusions in Patients Presenting with an Acute Coronary Syndrome: Collateral Flow Index and Correlation with Angiographic Collateral Grade

摘要

Clinical decisions regarding the need for revascularization are frequently made in patients with occlusive coronary disease following the delineation of coronary arterial anatomy by angiography. Therapeutic decisions in these patients are made on the basis of the extent and location of coronary lesions or obstructions. However, the presence and extent of collateral circulation are additional considerations. Rentrop et al. (1) have devised a simple grading scale to determine the degree of collateral circulation based on their angiographic appearance. Tin's grading system takes into account primarily the degree of filling of the recipient occluded artery. This angiographic grading system has been later validated in the chronic state (2-4) but has never been correlated with the pressures measured in the distal coronary artery beyond an obstruction in patients presenting with an occluded coronary artery during an acute coronary syndrome. In this study we measured through a full-length lumen (over the wire) balloon catheter the pressures within the distal lumen of an occluded coronary arteries. These pressures and their derived collateral flow indices, which represent flow afforded by collaterals as a fraction of normal anterograde flow, were correlated with observed angiographic collateral grade.