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PubMed1998

[Detection of coronary artery disease by adenosine triphosphate stress echocardiography: comparison with adenosine triphosphate stress thallium myocardial scintigraphy and coronary angiography].

The clinical feasibility and usefulness of adenosine triphosphate-2Na (ATP) stress echocardiography for the detection of coronary artery disease (CAD) were assessed. Two-dimensional echocardiography and thallium-201 single photon emission computed tomography (SPECT) during ATP infusion were performed simultaneously in 58 consecutive patients (41 men and 17 women; mean age 66 +/- 12 years) with suspected CAD. ATP was infused intravenously at 0.16 mg/kg/min for 5 min and thallium was injected at 4 min. All patients underwent coronary angiography within 2 weeks of ATP echocardiography and ATP SPECT. An ischemic response during ATP infusion was detected by echocardiography as the development or worsening of a wall motion abnormality compared with the baseline and by SPECT as a perfusion defect that filled totally or partially during redistribution. Significant coronary artery stenosis was defined as > or = 75% diameter stenosis in a major epicardial vessel. The severity of the stenosis was classified as follows: Group A, lesions with significant coronary artery stenosis (> or = 75%, < 90%); Group B, lesions with severe coronary artery stenosis (> or = 90%) without collateral circulation; Group C, lesions with severe coronary artery stenosis (> or = 90%) with collateral circulation. Significant CAD was present in 43 of 58 patients. The overall sensitivity, specificity and accuracy of ATP echocardiography for detecting significant CAD were 70%, 100% and 78%, respectively, and those of ATP SPECT were 98%, 87% and 95%, respectively. In patients without previous myocardial infarction, the sensitivity of ATP echocardiography was 67%. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia were 59% and 95% in patients with 1-vessel disease, 75% and 100% in those with 2-vessel disease, and 88% and 100% in those with 3-vessel disease, respectively. The induction of wall motion abnormality by ATP echocardiography was highly concordant with ATP SPECT imaging in patients with multivessel disease. Although the sensitivity of ATP echocardiography improved in patients with multivessel disease more than in those with single-vessel disease, detection of all diseased vessels was achieved in only 10% of patients with multivessel disease. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in individual vessels were: right coronary artery, 58% and 74%; left anterior descending artery, 59% and 97%; left circumflex artery, 27% and 68%. ATP-induced transient perfusion defects were associated with transient wall motion abnormality in only 57% of segments. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in patients with severe coronary stenosis were: Group A, 32% and 66%; Group B, 60% and 93%; Group C, 80% and 95%. The sensitivity of ATP echocardiography was significantly higher in the lesions with collateral circulation than in those without collateral circulation. ATP stress echocardiography is useful for detecting myocardial ischemia in patients with multivessel disease and in patients with severe coronary artery stenosis (> or = 90%). In particular, transient wall motion abnormality tends to be detected in the segments perfused by collateral circulation.

Adenosine Triphosphate↗
PubMed1984

Clinical significance of radionuclide studies in the acute phase of myocardial infarction.

Tl201 MPS and MGCBS were performed on patients with myocardial infarction in the acute phase and the results were evaluated using a scoring system. The findings obtained in this study can be summarized as follows. There was a significant difference in RNEF between Killip class I and III. Significantly high correlation was noted between RWM score and RNEF. In cases of low RNEF (less than 35%) with poor RWM (less than 7), the incidence of complications, especially malignant PVC (47%, P less than 0.01) was markedly high. There was no obvious correlation between Tl201 MPS and complications. However, adding low RNEF (35% or less) to poor Tl scores (-22 or less) malignant PVC was noted with high frequency. Tl scores on admission were not related to the number of coronary arteries involved. For patients with good Tl score and low RNEF on admission (suspected of having severe ischemia), EF did not necessarily showed a tendency toward improvement. Patients with single-, tow- or three-vessel disease showed no difference in improvement of EF at discharge. There was no marked difference in Tl score on admission among three groups of single lesion of left anterior descending artery; patients with total occlusion without collateral circulation, patients with collateral circulation and patients with recanalization.

Adult↗
PubMed1992

[The influence of findings of coronary artery on myocardial salvage in acute myocardial infarction].

201Tl stress myocardial scintigraphy was performed in convalescent patients with acute myocardial infarction, to evaluate the influence of stenosis and collateral circulation of coronary artery in acute phase, on myocardial salvage in chronic phase. In 14 cases of unsuccessful coronary revascularization (complete occlusion), a complete defect of thallium imaging in chronic phase was seen in only one case of four cases with good collateral circulation, while eight of 10 cases with poor collateral circulation. In 16 cases of poor collateral circulation, six cases showed a complete defect, although the target vessel had improved to less than 75% of stenosis. However, in cases of good collateral circulation, no case showed a complete defect when the target vessel had improved to less than 75% of stenosis. The myocardial salvage is quite possible (p less than 0.05), when the coronary angiography in acute phase showed the forward flow (99% or 90% of stenosis) before coronary revascularization and/or good collateral circulation (Rentrop 2 degrees or 3 degrees).

Adult↗
PubMed1997

[Topography of wound canals and possibilities of collateral blood circulation].

By complexed structural and functional study performed in 76 dogs in acute, subacute and chronic experiments, destruction of muscles of the extremity, intraorganic vascular bed of which does not participate in collateral blood circulation was shown not to be an impairing factor in vascular trauma. If the wound canal localization directly relates to the topography of most important collaterals pronounced structural and functional disorders of ischemic genesis develop in the organism and in the extremity within the next day. In case of primary adhesion of the soft tissue wound in the zone of collateral pathways or distinctly limited foci of purulent wound infection in any topography of wound canal acute arterial insufficiency is compensated due to mobilization of all vascular reserves. These are primarily arteries of remaining muscles and nerves, cutaneofascial vessels and arterial bed of the opposite extremity as well. On contrary, wound suppuration sharply suppresses vessel plastic properties, promotes tissue necrosis, including ischemic gangrene of the extremity distant segments. Basic dogma of anatomic experimental studies were supported by clinico-physiological evaluation of collateral circulation in the 16 wounded with vascular disturbances.

Animals↗
PubMed1995

Evaluation of repeated balloon inflation in angioplasty as a clinical model of ischemic preconditioning.

Reevaluation of repeated balloon angioplasty as a model of ischemic preconditioning and of the role of collateral circulation and high-frequency electrocardiograms in repeated inflations was carried out. There have been few studies using angioplasty as a model of ischemic preconditioning of the collateral circulation during repeated inflations or of the use of high-frequency electrocardiograms during angioplasty. Twenty patients underwent 3 repeated balloon inflations, each with a duration of more than 138 seconds. During inflation, ipsilateral and contralateral coronary angiography and signal-averaged electrocardiography were performed. At the 1st inflation, the ST segment gradually increased as the inflation time elapsed. During the 2nd and 3rd inflations, in which ST elevation was nearly equal, the ST segment gradually increased, but it was not as prominent as that at the 1st inflation; thus, the concept that ischemia is gradually ameliorated (adaptation to ischemia) was not documented. Comparison of the maximal ST elevation and ipsilateral and contralateral circulation at each inflation revealed that the ST segment became elevated and the contralateral collateral circulation increased significantly at the 1st inflation compared with those in the control. ST elevation, however decreased significantly and collateral circulation remained unchanged at the 2nd inflation; thus, collateral circulation did not cause the ST elevation decrease. The total root mean square voltage detected by signal averaging decreased significantly only at the 1st inflation. Balloon angioplasty is not always suitable as a model of ischemic preconditioning and collateral circulation is not the cause of ischemic preconditioning.

Aged↗
PubMed1993

A new method for assessment of collateral development after acute myocardial infarction.

OBJECTIVES: The purpose of this study was to test the hypothesis that the diameter of the recipient coronary artery of the well developed collateral circulation in patients with acute myocardial infarction increases because of the augmented intravascular pressure caused by subsequent collateral development. BACKGROUND: It is well known that collateral circulation develops after acute myocardial infarction. However, some patients have a well developed collateral circulation at the onset of infarction, which may limit the angiographic evaluation of further development of collateral circulation. METHODS: We measured the diameter of the donor and recipient arteries of the collateral circulation by means of a computer-assisted analysis system in seven patients with acute myocardial infarction who had a totally occluded infarct-related coronary artery during the acute and chronic stages of infarction. All coronary angiograms were obtained after the administration of sublingual nitroglycerin. The measurement was repeated immediately after (within 6 h) and late after (42 +/- 11 days) the onset of acute myocardial infarction. RESULTS: The diameter of the donor artery remained unchanged (1.32 +/- 0.98 vs. 1.42 +/- 1.12 mm). In contrast, the diameter of the recipient artery increased from 1.25 +/- 0.63 to 1.55 +/- 0.61 mm (p < 0.01). These changes in coronary artery diameter were associated with an improvement in regional myocardial wall motion at rest in infarct areas (6.7 +/- 7.0% vs. 13.6 +/- 10.7%, p < 0.05). CONCLUSIONS: These findings indicate that serial measurement of coronary artery diameter is useful for the evaluation of collateral development after acute myocardial infarction.

Aged↗
PubMed2002

Collateral coronary circulation in the absence of obstructive coronary artery disease.

The presence of collateral coronary circulation almost always accounts for significant obstructive coronary artery disease and its development remains unclear. We present two cases wherein there was a large collateral artery in a patient with angiographically normal coronary arteries. In both cases, the vessel ran in the atrioventricular groove, between the distal right coronary artery and the circumflex artery. We believe that this vessel is of congenital origin and after reviewing the literature we describe the angiographic features that distinguish such a vessel from collaterals that are secondary to coronary stenosis or hypoxia.

Aged↗
PubMedDate not supplied

Dipyridamole-induced increased glucose uptake in patients with single-vessel coronary artery disease assessed with PET.

BACKGROUND: The aim of this study was to determine the relationship between vasodilatation-induced ischemia and poststress glucose uptake. Coronary vasodilators may induce myocardial ischemia due to coronary steal through collateral circulation or transmural blood flow redistribution with diminished subendocardial perfusion. Myocardial ischemia can be demonstrated by increased glucose uptake as previously shown in patients with exercise-induced ischemia. METHODS AND RESULTS: We studied 11 patients with single-vessel disease and no history of myocardial infarction. Five patients had no collateral circulation, and 6 had angiographic evidence of collateral vessels. We measured myocardial blood flow (MBF) and glucose uptake at baseline and after the administration of dipyridamole (0.56 mg/kg) with positron emission tomography, using O-15 water and fluorine 18 deoxyglucose (FDG) as perfusion and glucose tracers. MBF at baseline was 0.82 +/- 0.13 mL/g/min in normal areas and 0.80 +/- 0.15 mL/g/min in areas supplied by stenotic arteries. MBF during dipyridamole was 2.05 +/- 0.66 and 1.19 +/- 0.66 mL/g/min in normal areas and areas with stenotic arteries, respectively (P < or = .001). FDG uptake at baseline was 1.36 +/- 0.55 in normal areas and 1.57 +/- 0.62 in areas supplied by stenotic arteries. FDG uptake after dipyridamole infusion was 1.79 +/- 1.1 and 4.04 +/- 0.84 in normal areas and areas with stenotic arteries, respectively (P < or =.001). MBF and FDG uptake were not different between patients with collateral circulation and those without collateral circulation. CONCLUSIONS: Increased myocardial glucose uptake was consistently observed after dipyridamole administration in those areas with diminished coronary vasodilatory capacity. The similar MBF and FDG findings in patients with and without collateral circulation may indicate that transmural blood flow redistribution appears to be a possible mechanism of dipyridamole-induced myocardial ischemia.

Blood Glucose↗
PubMed1979

[Correlations between splenoportographic findings and risk of digestive hemorrhage in portal hypertension].

In 102 cases examined by splenoportography (93 cirrhosis with patent splenoportal axis and 9 splenoportal thrombosis without appreciable liver changes), the occurrence of episodes of digestive haemorrhage was statistically correlated with age, sex, type of portal impediment, type of collateral circulation, and the presence or otherwise of ascites, and with portal pressure values measured by splenomanometry. The only statistically significant correlation was that concerning the type of hepatofugal collateral circulation, as digestive haemorrhage proved gradually less frequent in patients with gastro-oesophageal collateral circulation, in those with so-called infraportal collateral circulation and, finally, in those where angiography was unable to demonstrate the presence of any collateral circulation at all.

Adolescent↗
PubMed2004

The significance of the extracranial-intracranial anastomoses of carotid system in occlusion of internal carotid artery.

The existence of collateral circulation in patients with impaired intracranial circulation was studied. We analysed angiograms of 35 patients of the Neurology Clinic of Clinical Centre in Sarajevo with occlusion of internal carotid artery. In majority cases collateral circulation was not established. In patients with occlusion of internal carotid artery, extracranial-intracranial anastomoses were established in some cases, with results of surviving and patients recovery. Collateral circulation based on blood vessels which are formed in the early stages of fetal life. Some embryonal arteries undergo an involution process, while the other part of blood vessels stay unfunctional during life, until cerebrovascular disease appearence, when it comes to their activation. Establishing of the collateral circulation in post-occlusiv status depend on great number of factors: number of anastomoses, their calibre,velocity of occlusion and complete vascular status of patients.

Arterial Occlusive Diseases↗
PubMed1978

[Evaluation of the clinical severity in occlusion of the superficial femoral artery].

The judgment of the efficiency of the collateral circulation is of decisive importance for the estimation of the clinical degree of severity and thus also for the indication to angiosurgical measures. Since also angiographically only an indirect evidence concerning the collateral circulation can be given, the angiological findings of 18 patients with unilateral or bilateral occlusion of the superficial femoral artery (n = 25 lower extremities) were evaluated. On the basis of the measuring values received with the help of the phebembraxis plethysmography 3 degrees of severity may be differed which essentially correspond to clinical stage: 1. good collateral circulation (data in ml/100 ml tissue min: ff above 5 ml, pf above 15 ml, pf-time below 30 s 2. moderate collateral circulation: ff below 5 ml, pf below 15 ml, pf-time 30-60 s 3. bad collateral circulation: ff below 5 ml, pf below 10 ml, pf-time above 60 s. Of the measuring sizes (ff, pf, pf-time) the pf-time proved to be the most reliable parameter. On the basis of these results the phlebembraxis plethysmography is a valuble supplementation in the preoperative vascular diagnostics.

Arterial Occlusive Diseases↗