Published Online
on July 8, 2002

A more recent version of this article appeared on July 23, 2002

This Article Full Text (PDF) All Versions of this Article: 106/4/435    most recent 01.CIR.0000022848.92729.33v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Werner, G. S. Articles by Figulla, H. R. Search for Related Content PubMed Articles by Werner, G. S. Articles by Figulla, H. R. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC Chronic ischemic heart disease Coronary circulation

Submitted on March 15, 2002
Revised on May 9, 2002
Accepted on May 9, 2002

Direct Assessment of Coronary Steal and Associated Changes of Collateral Hemodynamics in Chronic Total Coronary Occlusions

Gerald S. Werner MD^* and Hans R. Figulla MD

From the Clinic for Internal Medicine III, Friedrich-Schiller-University, Jena, Germany.

^* To whom correspondence should be addressed. E-mail: gerald.werner{at}med.uni-jena.de.

Background—Coronary steal can occur in collateral-dependent myocardium during pharmacologically induced vasodilation. This study assessed coronary steal invasively in chronic total coronary occlusions (TCOs).

Methods and Results—In 35 consecutive patients with a percutaneous transluminal coronary angioplasty of a TCO (duration >4 weeks), coronary flow velocity (APV) by a Doppler wire and distal pressure (P_D) by a pressure wire were assessed in the collateral-dependent vascular bed before dilatation. Indexes of peripheral resistance (R_P) and for the collateral pathway, including the donor artery segment (R_CP), were calculated. Changes of these parameters were assessed during intravenous adenosine (140 µg · kg^-1 · min^-1). Adenosine caused a decrease of APV, ie, coronary steal, in 13 patients (37%; group S), an increase in 11 patients (group R), and no change in 11 patients (group N). Angiographic analysis of collateral pathways showed no difference between the groups, except that in group S all collateral connections were continuously visible but no large collaterals (>0.5 mm) were found. In group N, collaterals were least developed. The increase of APV in group R was associated with a decrease of R_P, whereas R_CP remained unchanged. In contrast, group S showed no change in R_P but a significant increase of R_CP, indicating an increased resistance of the donor segment.

Conclusions—Coronary steal is observed in about one third of TCOs and is associated with specific hemodynamic changes of R_P and R_CP. Steal occurred only with well-developed angiographically visible collaterals but not with very large collaterals.

Key words: collateral circulation • coronary disease • vasodilation

This article has been cited by other articles:

				P. Bernhardt, J. Spiess, B. Levenson, G. Pilz, B. Hofling, V. Hombach, and O. Strohm Combined Assessment of Myocardial Perfusion and Late Gadolinium Enhancement in Patients After Percutaneous Coronary Intervention or Bypass Grafts: A Multicenter Study of an Integrated Cardiovascular Magnetic Resonance Protocol J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1292 - 1300. [Abstract] [Full Text] [PDF]

				A. A. Boshchenko, A. V. Vrublevsky, and R. S. Karpov Transthoracic echocardiography in the detection of chronic total coronary artery occlusion Eur J Echocardiogr, January 1, 2009; 10(1): 62 - 68. [Abstract] [Full Text] [PDF]

				G. S. Werner, R. Surber, M. Ferrari, M. Fritzenwanger, and H. R. Figulla The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction Eur. Heart J., October 2, 2006; 27(20): 2406 - 2412. [Abstract] [Full Text] [PDF]

				D Perera, S Patel, L Blows, E Tomsett, M Marber, and S Redwood Pharmacological vasodilatation in the assessment of pressure-derived collateral flow index. Heart, August 1, 2006; 92(8): 1149 - 1150. [Full Text] [PDF]

				G. S. Werner, M. Fritzenwanger, D. Prochnau, G. Schwarz, M. Ferrari, W. Aarnoudse, N. H.J. Pijls, and H. R. Figulla Determinants of Coronary Steal in Chronic Total Coronary Occlusions: Donor Artery, Collateral, and Microvascular Resistance J. Am. Coll. Cardiol., July 4, 2006; 48(1): 51 - 58. [Abstract] [Full Text] [PDF]

				R. L. Wilensky, H. K. Song, and V. A. Ferrari Role of magnetic resonance and intravascular magnetic resonance in the detection of vulnerable plaques. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C48 - C56. [Abstract] [Full Text] [PDF]

				G S Werner, U Emig, P Bahrmann, M Ferrari, and H R Figulla Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion Heart, November 1, 2004; 90(11): 1303 - 1309. [Abstract] [Full Text] [PDF]

				G. S. Werner, M. Ferrari, S. Heinke, F. Kuethe, R. Surber, B. M. Richartz, and H. R. Figulla Angiographic Assessment of Collateral Connections in Comparison With Invasively Determined Collateral Function in Chronic Coronary Occlusions Circulation, April 22, 2003; 107(15): 1972 - 1977. [Abstract] [Full Text] [PDF]