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Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability?

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Abstract

The success rate of percutaneous coronary artery intervention (PCI) of chronic total occlusion (CTO) lesions have increased in the recent years. However, improvement of function is only possible when significant myocardial viability is present. One of the most important factors of maintaining myocardial viability is the opening and development of collaterals. Our hypothesis was that with a higher degree of collaterals more viable myocardium is present. In 38 patients we compared the degree of collaterals, evaluated with a conventional coronary angiogram (CCA) and graded by the Rentrop classification to transmural extent of the scar obtained in a viability study with magnetic resonance (MRI). We found a statistically significant association of the degree of collaterals determined with Rentrop method and transmural extent of the scar as measured by CMR (p = 0.001; Tau = -0.144). Additionally, associations showed an increase in the ratio between viable vs. non-viable myocardium with the degree of collaterals. Our study suggests that it may be beneficial to routinely grade the collaterals at angiography in patients with CTO as an assessment of myocardial viability.

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Author information

Authors and Affiliations

  1. Radiology Department, University Medical Centre Maribor, Maribor, Slovenia

    Maja Pirnat

  2. Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia

    Marko Noc

  3. Medical University Graz, Graz, Austria

    Rainer Rienmueller

  4. Department of Radiology and Imaging Sciences Cardiothoracic Imaging, Emory Universitiy School of Medicine, Atlanta, USA

    Arthur E. Stillman

  5. Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia

    Mario Gorenjak

  6. Radiology Department, University Clinical Center, Maribor, Slovenia

    Tomaž Šeruga

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  1. Maja Pirnat
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Pirnat, M., Stillman, A.E., Rienmueller, R. et al. Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability?. Int J Cardiovasc Imaging 37, 379–388 (2021). https://doi.org/10.1007/s10554-020-01984-5

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  • DOI: https://doi.org/10.1007/s10554-020-01984-5

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