Billinger M, Fleisch M, Eberli F R, Meier B, Seiler C
University Hospital, Swiss Cardiovascular Center Bern, Cardiology, Bern, Switzerland.
Cardiovasc Res. 2001 Feb 16;49(3):600-8. doi: 10.1016/s0008-6363(00)00175-9.
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.
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.
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.
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.
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。
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。
两组中待扩张的冠状动脉直径狭窄百分比（%-S）相似：78±10% 对 82±12%（无显著性差异）。CFVR与%-S无关。在CFI>或 =0.15组而非CFI<0.15组中，CFVR分别与R(coll)和R(contra)呈直接和反向相关。
在CAD患者且这些区域之间侧支循环良好的患者中，可以证明相邻血管区域之间存在血流动力学相互作用。因此，侧支循环区域的CFVR可能更依赖于侧支循环和侧支循环供血区域的充血血管阻力变化，而不是同侧狭窄的严重程度，甚至可能降至1以下。
