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The haemodynamic effects of collateral donation to a chronic total occlusion : implications for patient management

Ladwiniec, Andrew; Hoye, Angela


Andrew Ladwiniec

Angela Hoye


Physiological lesion assessment in the form of Fractional Flow Reserve (FFR) is now well established for the purpose of guiding multi-vessel revascularization. Chronic total coronary occlusions are frequently associated with multi-vessel disease and the collateral dependent myocardium distal to the occlusion is often supplied by a collateral supply from another epicardial coronary artery. The haemodynamic effect of collateral donation upon collateral donor vessel flow may have important implications for the vessel's FFR; rendering it unreliable at predicting ischaemia should the CTO be revascularized. As a consequence, in the setting of multi-vessel disease, optimal revascularization strategy might be altered. There is a paucity of work in the medical literature directly examining this phenomenon. We endeavoured to review the existing literature related to it, to summarise from current knowledge of coronary physiology what is known about the potential effects of CTO revascularization on both collateral flow and collateral donor vessel physiology, and to highlight where further studies might inform practice.


Ladwiniec, A., & Hoye, A. (2015). The haemodynamic effects of collateral donation to a chronic total occlusion : implications for patient management. International journal of cardiology, 198, 159-166.

Acceptance Date Jun 29, 2015
Online Publication Date Jul 6, 2015
Publication Date Nov 1, 2015
Deposit Date Sep 8, 2015
Publicly Available Date Nov 23, 2017
Journal International journal of cardiology
Print ISSN 0167-5273
Electronic ISSN 1874-1754
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 198
Pages 159-166
Keywords Chronic total coronary occlusion; Collateral circulation; Fractional flow reserve; Coronary physiology
Public URL
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Additional Information Authors' accepted manuscript of article published in: International journal of cardiology, 2015, v.198


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