Increased Plasma Non-High-Density Lipoprotein Levels and Poor Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease

BACKGROUND

This study investigated the relationship between coronary collateral circulation (CCC) and non-high-density lipoprotein cholesterol (non-HDL-C) in patients with stable coronary artery disease (CAD). Coronary collateral circulation plays a critical role in supporting blood flow, particularly in the ischemic myocardium. Previous studies show that non-HDL-C plays a more important role in the formation and progression of atherosclerosis than do standard lipid parameters.

METHODS

A total of 226 patients with stable CAD and stenosis of more than 95% in at least 1 epicardial coronary artery were included in the study. Rentrop classification was used to assign patients into group 1 (n = 85; poor collateral) or 2 (n = 141; good collateral). To adjust for the observed imbalance in baseline covariates between study groups, propensity-score matching was used. Covariates were diabetes, Gensini score, and angiotensin-converting enzyme inhibitor use.

RESULTS

In the propensity-matched population, the plasma non-HDL-C level (mean [SD], 177.86 [44.0] mg/dL vs 155.6 [46.21] mg/dL; P = .001) was statistically higher in the poor-collateral group. LDL-C (odds ratio [OR], 1.23; 95% CI, 1.11-1.30; P = .01), non-HDL-C (OR, 1.34; 95% CI, 1.20-1.51; P = .01), C-reactive protein (OR, 1.21; 95% CI, 1.11-1.32; P = .03), systemic immune-inflammation index (OR, 1.14; 95% CI, 1.05-1.21; P = .01), and C-reactive protein to albumin ratio (OR, 1.11; 95% CI, 1.06-1.17; P = .01) remained independent predictors of CCC in multivariate logistic regression analysis.

CONCLUSION

Non-HDL-C was an independent risk factor for developing poor CCC in stable CAD.

Internal Trapping of an Acutely Ruptured Dissecting Aneurysm of a Dominant Vertebral Artery Following Balloon Test Occlusion: A Case Report

Objective

To report a case of an acutely ruptured vertebral artery dissecting aneurysm (VADA) with a hypoplastic contralateral vertebral artery (VA) successfully treated with internal trapping following the estimation of the collateral flow from anterior circulation.

Case Presentation

A 46-year-old woman was diagnosed with subarachnoid hemorrhage and acute hydrocephalus. Ventriculostomy was performed under general anesthesia. CTA revealed a left VADA distal to the origin of the left posterior inferior cerebellar artery (PICA). The right VA was hypoplastic, and the right posterior communicating artery (Pcom) was fetal type. We performed balloon test occlusion (BTO) of the VA proximal to the origin of the left PICA and estimated sufficient collateral blood flow via the right Pcom and basilar artery (BA) to the anterior spinal artery (ASA) and the left PICA. Internal trapping of the left VADA was then performed. The angiograms after internal trapping revealed collateral flow from the right Pcom to the BA, and the hypoplastic right VA perfused the proximal BA and ASA. She recovered without any neurological deficits following antiplatelet therapy and vasospasm treatment. She was followed up for 6 years without any neurological events occurring.

Conclusion

When BTO indicates sufficient collateral flow, internal trapping could be a useful treatment for acutely ruptured VADAs on the dominant side, given a complete understanding of the angioarchitecture and the risk of vasospasm due to subarachnoid hemorrhage.