|
1
|
Allahwala UK, Brilakis ES, Byrne J, Davies JE, Ward MR, Weaver JC, Bhindi R. Applicability and Interpretation of Coronary Physiology in the Setting of a Chronic Total Occlusion. Circ Cardiovasc Interv 2019; 12:e007813. [PMID: 31272226 DOI: 10.1161/circinterventions.119.007813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Concurrent coronary artery disease in a vessel remote from a chronic total occlusion (CTO) is common and presents a management dilemma. While the use of adjunctive coronary physiology to guide revascularization is now commonplace in the catheterization laboratory, the presence of a CTO provides a unique and specific situation whereby the physiological assessment is more complex and relies on theoretical assumptions. Broadly, the physiological assessment of a CTO relies on assessing the function and regression of collaterals, the assessment of the microcirculation, the impact of collateral steal as well as assessing the severity of a lesion in the donor vessel (the vessel supplying the majority of collaterals to the CTO). Recent studies have shown that physiological assessment of the donor vessel in the setting of a CTO may overestimate the severity of stenosis, and that after revascularization of a CTO, the index of ischemia may increase, potentially altering the need for revascularization. In this review article, we present the current literature on physiological assessment of patients with a CTO, management recommendations and identify areas for ongoing research.
Collapse
Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.).,Sydney Medical School, University of Sydney, NSW, Australia (U.K.A., R.B.)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (E.S.B.).,Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas (E.S.B.)
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London, United Kingdom (J.B.)
| | - Justin E Davies
- Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom (J.E.D.)
| | - Michael R Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.)
| | - James C Weaver
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (J.C.W.).,School of Medicine, University of New South Wales, Sydney, Australia (J.C.W.)
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.).,Sydney Medical School, University of Sydney, NSW, Australia (U.K.A., R.B.)
| |
Collapse
|