title: Angiographic estimation of atherosclerotic disease burden in a coronary artery fed by collaterals: a potential pitfall in decision for revascularization.
abstract: Despite the remarkable advances in revascularization strategies made during the last decade, a significant proportion of patients are excluded from either percutaneous coronary intervention or coronary artery bypass grafting because of unsuitable coronary anatomy. Diffuse severe coronary artery disease, small vessel caliber, chronic total occlusions, or extremely calcified vessels are frequent reasons for deferring revascularization with either percutaneous coronary intervention or coronary artery bypass grafting. We present a case concerning a middle-aged asymptomatic patient who was treated successfully with percutaneous coronary intervention due to a chronic total occlusion lesion of the left anterior descending artery. Coronary angiography is an inadequate method for the estimation of the burden of atherosclerotic disease in an artery fed by collaterals. Assessment of any residual antegrade flow, and ipsilateral and contralateral collateral filling of the segments distal to the occlusion with invasive or noninvasive techniques, could affect the appropriate decision-making by physicians.
authors.affiliation: Cardiology Department, University Hospital of Patras, Patras, Greece. gregtsig@hotmail.com
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tsigkas
authors.forename: Panagiota
authors.initials: P
authors.lastname: Mylona
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D058070:Asymptomatic Diseases; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D015607:Stents; D016896:Treatment Outcome