Why the study?
Does the development of coronary collaterals cause decreased perfusion in the normal donor artery myocardial region in patients with single vessel exertional angina?
Does the development of coronary collaterals cause decreased perfusion in the normal donor artery myocardial region in patients with single vessel exertional angina?
Coronary collaterals can cause a steal phenomenon leading to reversible perfusion defects in the normal donor artery myocardial region.
May suggest donor-artery steal in collateralized angina; leaves open causality and clinical relevance.
Thirty-one patients suffering from single vessel exertional angina with collaterals (Group A) were evaluated by stress 201T1 myocardial emission CT (Tl-SPECT) with 16 controls of severely stenotic single vessel exertional angina without collaterals (Group B). Group A included 21 patients (68%) who showed an extensive perfusion defect in double artery myocardial regions, including the normal donor artery myocardial region (DMR). However, there were no such cases in Group B, giving a significant difference between these 2 groups (p less than 0.001). Four patients in Group A, having a perfusion defect both in DMR and in the collateral dependent myocardial region (CMR) underwent a successful percutaneous transluminal coronary angioplasty (PTCA) with disappearance of collaterals. Tl-SPECT findings after PTCA showed no perfusion defect either in CMR or in DMR. This has been explained on the basis that the coronary collaterals stole blood and produced perfusion defect in DMR.
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Koga et al. (1992) studied this question.
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