History of CTO Intervention and Benefits of CTO PCI
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Coronary occlusion
Collateral circulation
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The predictors and prognostic implications of well-matured collaterals in those with a chronic total occlusion (CTO) are unknown. We sought to identify the determinants of collateral maturation and to determine its effects on procedural outcomes and prognosis.Patients presenting for CTO percutaneous coronary intervention (PCI) between April 2010 and July 2019 were included. Patients with a previous coronary artery bypass (CABG) to the CTO and those with only bridging collaterals were excluded. The degree of collateral maturation was determined by the Rentrop grading classification. Demographic, biochemical, and anatomical factors and procedural and longer-term outcomes were identified.A total of 212 patients were included in the study. Patients with well-matured collaterals were more likely to be females (29.7% versus 15.2% versus 0%, P < 0.005 for Rentrop grade 3, 2, and 0 or 1, respectively), less likely to have chronic kidney disease (CKD) (8.8% versus 4.5% versus 19.2%, P < 0.05) and less likely to have had a prior CABG (15.6% versus 18.7% versus 19.2%). Patients with well-matured collaterals had lower neutrophil-to-leukocyte ratio (NLR) (2.8 versus 4.0 versus 5.7, P < 0.0001). Patients with well-matured collaterals were more likely to have procedural success (90.5% versus 62.5% versus 34.6%, P < 0.0001). The degree of collateral maturation was not associated with longer-term mortality.Improved collateral maturation was associated with female sex and lower rates of CKD and CABG and a lower NLR. Those with well-matured collaterals had a significantly higher rate of procedural success but not improved prognosis.
Collateral circulation
Coronary occlusion
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Collateral circulation
Coronary occlusion
Coronary circulation
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Collateral circulation
Coronary occlusion
Coronary circulation
Circulation (fluid dynamics)
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Collateral circulation
Coronary occlusion
Coronary circulation
Circulation (fluid dynamics)
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Collateral circulation
Coronary occlusion
Circulation (fluid dynamics)
Coronary circulation
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Collateral circulation
Coronary circulation
Coronary occlusion
Circulation (fluid dynamics)
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The effects of glyceryl trinitrate on collateral blood flow and regional myocardial function during a 2 min coronary occlusion were evaluated in 10 conscious dogs with well developed collateral vessels. Collateral growth was promoted by brief, repeated, reversible coronary occlusions. After partial regression in collateral function a small dose of glyceryl trinitrate (5 micrograms.kg-1) was injected intravenously 1 min before coronary occlusion. After pretreatment with glyceryl trinitrate the collateral blood flow velocity (mean[SD]) increased from 3.0(0.9) to 4.4(1.4) cm.s-1 (p less than 0.05). After 2 min of occlusion the percentage systolic subendocardial segment shortening in the collateral dependent zone increased from 7.8(6.1) to 12.6(6.7)% (p less than 0.05). The blood flow debt repayment after release of the occlusion decreased from 122(41) to 68(34%) (p less than 0.05). Thus in conscious dogs with regressed newly developed collaterals a major component of the beneficial effects of glyceryl trinitrate on collateral circulation is dilatation of collateral vessels, as evidenced by a pronounced increase in collateral blood flow and myocardial function during a transient period of coronary occlusion.
Collateral circulation
Coronary occlusion
Coronary circulation
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Collateral circulation
Coronary occlusion
Coronary circulation
Coronary artery occlusion
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Experiments were performed on 18 anesthetized open-chest dogs to observe the changes in platelet aggregation and coronary collateral circulation during the early phase of acute myocardial ischemia. An increase in platelet aggregation rates (PAgR) and a decrease in platelet counts (PC) were found in the blood collected from the ischemic myocardium after coronary occlusion. PAgR was increased by 58.7 +/- 5.6% and PC was reduced by 39.5 +/- 23.6% at 50 min after occlusion (P less than 0.01). Under the condition of controlling aortic blood pressure, collateral coronary vascular capacity (CVC) was not changed (P greater than 0.05), but the effective collateral coronary flow to the ischemic zone, calculated by Wyatt et al's equation, was significantly reduced by 23.5 +/- 9.7% at 50 min after occlusion (P less than 0.05). There was a negative correlation between the changes in PAgR and the effective collateral coronary flow ( r = -0.857, P less than 0.01), and between the collateral indices and infarct size (r = -0.847, P less than 0.01). Abnormal changes in parameters of platelet and coronary collateral circulation after myocardial ischemia were nearly abolished by intravenous injection of aspirin before coronary occlusion. The results suggest that the deleterious changes of platelet aggregation during the early phase of the acute myocardial ischemia may decrease the effective collateral coronary flow significantly and thereby enlarge the infarct size.
Collateral circulation
Coronary occlusion
Coronary circulation
Aortic pressure
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