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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

Authors

Andrew Ladwiniec

Michael S. Cunnington

Jennifer Rossington

Simon Thackray

Farquad Alamgir



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 Mar 28, 2024
Journal Catheterization and cardiovascular interventions
Print ISSN 1522-1946
Electronic ISSN 1522-726X
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.

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