侧支及侧支相邻充血血管阻力变化与同侧冠状动脉血流储备。冠状动脉疾病患者中导致冠状动脉窃血机制的记录。

Collateral and collateral-adjacent hyperemic vascular resistance changes and the ipsilateral coronary flow reserve. Documentation of a mechanism causing coronary steal in patients with coronary artery disease.

作者信息

Billinger M, Fleisch M, Eberli F R, Meier B, Seiler C

机构信息

University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland.

出版信息

Cardiovasc Res. 2001 Feb 16;49(3):600-8. doi: 10.1016/s0008-6363(00)00175-9.

DOI:10.1016/s0008-6363(00)00175-9

PMID:11166273

Abstract

OBJECTIVES

The goal of this clinical study was to assess the influence of hyperemic ipsilateral, collateral and contralateral vascular resistance changes on the coronary flow velocity reserve (CFVR) of the collateral-receiving (i.e. ipsilateral) artery, and to test the validity of a model describing the development of collateral steal.

METHODS

In 20 patients with one- to two-vessel coronary artery disease (CAD) undergoing angioplasty of one stenotic lesion, adenosine induced intracoronary (i.c.) CFVR during vessel patency was measured using a Doppler guidewire. During stenosis occlusion, simultaneous i.c. distal ipsilateral flow velocity and pressure (P(occl), using a pressure guidewire) as well as contralateral flow velocity measurements via a third i.c. wire were performed before and during intravenous adenosine. From those measurements and simultaneous mean aortic pressure (P(ao)), a collateral flow index (CFI), and the ipsilateral, collateral, and contralateral vascular resistance index (R(ipsi), R(coll), R(contra)) were calculated. The study population was subdivided into groups with CFI<0.15 and with CFI> or =0.15.

RESULTS

The percentage-diameter coronary artery stenosis (%-S) to be dilated was similar in the two groups: 78+/-10% versus 82+/-12% (NS). CFVR was not associated with %-S. In the group with CFI> or =0.15 but not with CFI<0.15, CFVR was directly and inversely associated with R(coll) and R(contra), respectively.

CONCLUSIONS

A hemodynamic interaction between adjacent vascular territories can be documented in patients with CAD and well developed collaterals among those regions. The CFVR of a collateralized region may, thus, be more dependent on hyperemic vascular resistance changes of the collateral and collateral-supplying area than on the ipsilateral stenosis severity, and may even fall below 1.

摘要

目的

本临床研究的目的是评估同侧充血、侧支循环及对侧血管阻力变化对接受侧支循环（即同侧）动脉的冠状动脉血流储备（CFVR）的影响，并检验描述侧支循环窃血发展的模型的有效性。

方法

对20例患有一到两支血管冠状动脉疾病（CAD）且正在接受一处狭窄病变血管成形术的患者，在血管通畅时使用多普勒导丝测量腺苷诱发的冠状动脉内（i.c.）CFVR。在狭窄闭塞期间，在静脉注射腺苷之前和期间，使用压力导丝同时测量同侧远端i.c.流速和压力（P(occl)）以及通过第三根i.c.导丝测量对侧流速。根据这些测量值以及同时测量的平均主动脉压力（P(ao)），计算侧支血流指数（CFI）以及同侧、侧支循环和对侧血管阻力指数（R(ipsi)、R(coll)、R(contra)）。研究人群被分为CFI<0.15组和CFI>或 =0.15组。