Coronary Collateral Circulation during Balloon Angioplasty in Patients with Ischemic Heart Disease Ikuo Moriuchi 1 , Sumio Mizuno 1 , Yoshifumi Takahashi 1 , Kazuo Ohsato 1 , Tatsuaki Murakami 1 , Yoshiyuki Arai 1 , Yutaka Nio 1 , Bunji Kaku 1 1Department of Internal Medicine, Fukui Cardiovas-cular Center Keyword: 経皮的冠動脈形成術 , 側副血行 , ドップラーガイドワイヤー , percutaneous transluminal coronary angioplasty , collateral circulation , Doppler guide wire pp.379-383
Published Date 1997/4/15
DOI https://doi.org/10.11477/mf.1404900030
  • Abstract
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We investigated the clinical significance of coronary collateral circulation during balloon inflation for per-cutaneous transluminal coronary angioplasty (PTCA) in patients with ischemic heart disease. The subjects con-sisted of 28 patients (20 males and 8 females with a mean age of 62 years) who underwent PTCA in the left ante-rior descending artery (LAD). There were 7 patients with acute myocardial infarction (AMI), 9 with old myocardial infarction (OMI), and 12 with angina pector-is (AP). The duration of balloon inflation was 90 seconds in all subjects. The coronary collateral flow velocity was measured by using a Doppler guide wire inflated for 45 seconds. Contralateral and ipsilateral coronary angio-graphy was performed at 60 seconds of inflation. Coro-nary collateral circulation was evaluated with Rentrop's classification grading from G0 to G3. Changes in ST-segment on ECG and intracoronary ECG (ic ECG) were also recorded. Coronary collateral circulation was evaluated as G0 in 3 patients (11%), G1 in 4(14%), G2 in 14(50%) and G3 in 7(25%). Results were listed depend-ing on these grades. Data (mean±SE) were obtained at the first inflation in all patients and statistically anal-yzed with variance analysis. Changes in ST-segment on ECG were 8.7±3.5 mm (G0), 8.3±2.5 mm (G1), 4.0±0.6 mm (G2) and 1.6±0.9 mm (G3) respectively (p<0.005). The coronary collateral flow velocities were 1.5±0.2 cm/sec (G0), 1.7±0.3 cm/sec (G1), 3.8±0.5 cm/sec (G2) and 10±1.7 cm/sec (G3) respectively (p<0.0001). There have been few reports on collateral circulation during PTCA-balloon inflation, although such studies are clinically important. In the present study, a significant correlation was found between the angiographic classification of collateral circulation and heart muscle ischemia confirmed by changes in ST-segment on ECG and the collateral flow velocity. Coronary collateral circulation during balloon inflation has protective effects for the heart muscle during acute coronary occlu-sion.

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