Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions.
BACKGROUND
The evaluation of new therapeutic modalities to induce collateral growth in coronary artery disease require improved methods of angiographic characterization of collaterals, which should be validated by quantitative assessment of collateral function.


RESULTS
In 100 patients with total chronic occlusion of a major coronary artery (duration >2 weeks) collaterals were assessed angiographically by the Rentrop grading, by their anatomic location, and by a new grading of collateral connections (CC grade 0: no continuous connection, CC1: threadlike continuous connection, CC2: side branch-like connection). The interobserver variability was 10%. Collateral function was assessed by Doppler flow (average peak velocity) and pressure recordings distal to the occlusion before recanalization. A collateral resistance index (RColl) was calculated. Recruitable collateral flow was measured during a final balloon inflation >30 minutes after the baseline measurement. The comparison of the anatomic location, the Rentrop, and the collateral connection grade showed only for the latter an independent and significant relation with RColl. CC2 collaterals preserved regional left ventricular function better than did CC1 collaterals and provided a higher collateral flow reserve during adenosine infusion. CC0 collaterals were predominantly observed in recent occlusions of 2 to 4 weeks' duration, with the highest RColl. During balloon reocclusion, recruitable collateral function was best preserved with CC2 and least with CC0.


CONCLUSIONS
The angiographic grading of collateral connections in total chronic occlusions could differentiate collaterals according to their functional capacity to preserve regional left ventricular function and was closely associated with invasively determined parameters of collateral hemodynamics.
Werner
Gerald S
GS
Clinic for Internal Medicine III, Friedrich-Schiller-University Jena, Jena, Germany. gerald.werner@med.uni-jena.de
Ferrari
Markus
M
Heinke
Stephan
S
Kuethe
Friedhelm
F
Surber
Ralf
R
Richartz
Barbara M
BM
Figulla
Hans R
HR
D000241:Adenosine / Q000494:pharmacology; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D014465:Ultrasonics; D018084:Ultrasonography, Interventional; D014654:Vascular Patency; D014655:Vascular Resistance / Q000187:drug effects
D000241:Adenosine