title: Reversal of ischemia of donor artery myocardium after recanalization of a chronic total occlusion.
abstract: BACKGROUND
  Case reports have shown that an intermediate stenosis in the donor artery collateralizing the myocardium of a chronic total occlusion (CTO) can produce an ischemic fractional flow reserve (FFR) value which may revert to non-ischemic with CTO revascularization.
  
  
  METHODS
  A consecutive series of patients with severe angina in which a donor artery with intermediate stenosis (30-70%) had FFR measured before and after successful CTO recanalization were studied.
  
  
  RESULTS
  Fourteen of 50 consecutive CTO patients with successful PCI fulfilled the study criteria. Eight had CTO of the right coronary artery (RCA), three circumflex (LCx), and three RCA and LCx. Left anterior descending artery was the donor artery in 13 and LCx in 1 patient. Of nine donor ischemic FFR patient's pre-PCI, six reverted to non-ischemic (FFR pre-PCI 0.76 ± 0.04 and 0.86 ± 0.03 post-PCI). Five patients had normal FFR in the donor artery pre- and post-CTO PCI.
  
  
  CONCLUSIONS
  In patients with a CTO and an intermediate donor artery stenosis, the frequency of ischemia in the donor artery territory is relatively high and often normalized by successful CTO recanalization. These data recommend recanalizing the CTO first whenever possible as a preferred therapeutic strategy to avoid the need for PCI to the donor artery or multivessel bypass surgery.
authors.affiliation: Department of Internal Medicine, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Wellstar Cardiology, North Fulton Hospital, Roswell, Georgia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sachdeva
authors.forename: Mayank
authors.initials: M
authors.lastname: Agrawal
authors.forename: Shawn E
authors.initials: SE
authors.lastname: Flynn
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D002908:Chronic Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome
keywords: chronic total occlusion; coronary revascularization; fractional flow reserve; ischemia; percutaneous coronary intervention