Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study.
OBJECTIVE
To evaluate whether a well developed collateral circulation predisposes to restenosis after percutaneous coronary intervention (PCI).


METHODS
Prospective observational study.


METHODS
58 patients undergoing elective single vessel PCI in a tertiary referral interventional cardiac unit in the UK.


METHODS
Collateral flow index (CFI) was calculated as (Pw-Pv)/(Pa-Pv), where Pa, Pw, and Pv are aortic, coronary wedge, and right atrial pressures during maximum hyperaemia. Collateral supply was considered poor (CFI < 0.25) or good (CFI > or = 0.25).


METHODS
In-stent restenosis six months after PCI, classified as neointimal volume > or = 25% stent volume on intravascular ultrasound (IVUS), or minimum lumen area < or = 50% stent area on IVUS, or minimum lumen diameter < or = 50% reference vessel diameter on quantitative coronary angiography.


RESULTS
Patients with good collaterals had more severe coronary stenoses at baseline (90 (11)% v 75 (16)%, p < 0.001). Restenosis rates were similar in poor and good collateral groups (35% v 43%, p = 0.76 for diameter restenosis, 27% v 45%, p = 0.34 for area restenosis, and 23% v 24%, p = 0.84 for volumetric restenosis). CFI was not correlated with diameter, area, or volumetric restenosis (r2 < 0.1 for each). By multivariate analysis, stent diameter, stent length, > 10% residual stenosis, and smoking history were predictive of restenosis.


CONCLUSIONS
A well developed collateral circulation does not predict an increased risk of restenosis after PCI.
Perera
D
D
Department of Cardiology, Rayne Institute, St Thomas' Hospital Campus, King's College London, UK.
Postema
P
P
Rashid
R
R
Patel
S
S
Blows
L
L
Marber
M
M
Redwood
S
S
D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D014463:Ultrasonography