[Collaterals do not prevent infarcts in subacute vascular stenosis following initially successful vascular stent implantation].
Sufficient collateralization may prevent acute myocardial infarction despite complete obstruction of a coronary artery. Nevertheless, it is unclear if collaterals which regressed after restoration of antegrade flow may be recruited fast enough to prevent myocardial infarction in case of subacute coronary artery thrombosis. In 50 patients (pts) (48 males, two females, age 60 +/- 7.6 years) with high-grade coronary artery stenosis and collaterals from the contralateral non-diseased coronary artery, stenting devices (Palmaz-Schatz) were implanted. In seven patients subacute thrombosis of the stent occurred. Six patients developed myocardial infarcts with a CKmax greater than 100 U/l (mean 943 +/- 635 U/l). One patient was treated by intravenous thrombolysis, three pts with acute PTCA, one patient with both, and one patient had CABG after unsuccessful PTCA; no patient died. There was no statistical correlation to the degree of collateralization and time after, or location of stent implantation, most likely because of the small number of cases.


CONCLUSIONS
This retrospective study shows that collaterals in humans with a high-grade coronary artery stenosis which has regressed after restoration of sufficient antegrade blood-flow cannot be recruited fast enough to prevent myocardial necrosis in case of subacute coronary artery occlusion. This is in contrast to earlier results obtained in animal studies.
Görge
G
G
Medizinische Klinik, Universität Mainz.
Erbel
R
R
Haude
M
M
Straub
U
U
Meyer
J
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy
Kollateralen verhindern nicht Infarkte bei subakuten Gefässverschulüssen nach initial erfolgreicher Gefässstützen-implantation.