title: Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention.
abstract: OBJECTIVE
  Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment.
  
  
  RESULTS
  In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure-derived collateral flow index (CFI) was determined as (P(w)-P(cvp))/(P(a)-P(cvp)), where P(w) represents coronary wedge pressure, P(cvp) central venous pressure, and P(a) mean aortic blood pressure. Both were measured during transient coronary occlusion by a balloon inflation of 30 s. Pre-interventional FFR (0.65 +/- 0.20) correlated inversely with the CFI (0.18 +/- 0.11), r =- 0.356, P < 0.001. After 9 months, binary angiographic restenosis (>/=50% diameter stenosis) was seen in 29.1%. Compared to patients with poorly developed collaterals (CFI < 0.25), patients with well-developed collaterals (CFI >/= 0.25) had a lower pre-interventional FFR (0.50 +/- 0.14 vs. 0.72 +/- 0.18, P < 0.001), a higher CFI (0.33 +/- 0.08 vs. 0.13 +/- 0.07, P < 0.001), and a higher binary restenosis rate (54.2% vs. 19.4, P = 0.003). CFI*100 was an independent predictor of restenosis after 9 months (odds ratio 1.07, 95% CI 1.02-1.12, P = 0.016).
  
  
  CONCLUSIONS
  Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents.
authors: Department of Cardiology, Catheterization Laboratory, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. okkels@dadlnet.dk
authors: Lisette Okkels
authors: LO
authors: Jensen
authors: Per
authors: P
authors: Thayssen
authors: Jens Flensted
authors: JF
authors: Lassen
authors: Henrik Steen
authors: HS
authors: Hansen
authors: Henning
authors: H
authors: Kelbaek
authors: Anders
authors: A
authors: Junker
authors: Knud Erik
authors: KE
authors: Pedersen
authors: Knud Nørregaard
authors: KN
authors: Hansen
authors: Lars Romer
authors: LR
authors: Krusell
authors: Hans Erik
authors: HE
authors: Botker
authors: Leif
authors: L
authors: Thuesen
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002496:Central Venous Pressure; D003097:Collateral Circulation; D017023:Coronary Angiography; D023903:Coronary Restenosis; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors