Microvascular dysfunction in the immediate aftermath of chronic total coronary occlusion recanalization

Ladwiniec, Andrew; Cunnington, Michael S.; Rossington, Jennifer; Thackray, Simon; Alamgir, Farquad; Hoye, Angela

Abstract

Objectives The aim of this study was to compare microvascular resistance under both baseline and hyperemic conditions immediately after percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) with an unobstructed reference vessel in the same patient. Background Microvascular dysfunction has been reported to be prevalent immediately after CTO PCI. However, previous studies have not made comparison with a reference vessel. Patients with a CTO may have global microvascular and/or endothelial dysfunction, making comparison with established normal values misleading. Methods After successful CTO PCI in 21 consecutive patients, coronary pressure and flow velocity were measured at baseline and hyperemia in distal segments of the CTO/target vessel and an unobstructed reference vessel. Hemodynamics including hyperemic microvascular resistance (HMR), basal microvascular resistance (BMR), and instantaneous minimal microvascular resistance at baseline and hyperemia were calculated and compared between reference and target/CTO vessels. Results After CTO PCI, BMR was reduced in the target/CTO vessel compared with the reference vessel: 3.58 mm Hg/cm/s vs 4.94 mm Hg/cm/s, difference −1.36 mm Hg/cm/s (−2.33 to −0.39, p = 0.008). We did not detect a difference in HMR: 1.82 mm Hg/cm/s vs 2.01 mm Hg/cm/s, difference −0.20 (−0.78 to 0.39, p = 0.49). Instantaneous minimal microvascular resistance correlated strongly with the length of stented segment at baseline (r = 0.63, p = 0.005) and hyperemia (r = 0.68, p = 0.002). Conclusions BMR is reduced in a recanalized CTO in the immediate aftermath of PCI compared to an unobstructed reference vessel; however, HMR appears to be preserved. A longer stented segment is associated with increased microvascular resistance.

Citation

Ladwiniec, A., Cunnington, M. S., Rossington, J., Thackray, S., Alamgir, F., & Hoye, A. (2016). Microvascular dysfunction in the immediate aftermath of chronic total coronary occlusion recanalization. Catheterization and Cardiovascular Interventions, 87(6), 1071-1079. https://doi.org/10.1002/ccd.26392

• Acceptance Date: Dec 13, 2015
• Online Publication Date: Jan 12, 2016
• Publication Date: 2016-05
• Deposit Date: Jun 22, 2016
• Publicly Available Date: Jun 22, 2016
• Journal: Catheterization and cardiovascular interventions
• Print ISSN: 1522-1946
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 87
• Issue: 6
• Pages: 1071-1079
• DOI: https://doi.org/10.1002/ccd.26392
• Keywords: CTO, PCI, Microvascular resistance
• Public URL: https://hull-repository.worktribe.com/output/440028
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/ccd.26392/abstract
• Additional Information: Authors' accepted manuscript of an article which has been published in: Catheterization and cardiovascular interventions, 2016, v.87, issue 6.
• Contract Date: Jun 22, 2016