Key Points
- To document and evaluate the hemodynamic mechanisms underlying adenosine-induced coronary collateral steal in a collateralized coronary circulation.
- Measured intracoronary blood flow velocity using an intravascular Doppler guidewire at baseline and during adenosine-induced hyperemia in a patient with a reopened left circumflex coronary artery.
- Assessed blood flow velocity reserve before and after complete revascularization of the culprit coronary lesion.
- Hyperemic stress triggered a coronary steal phenomenon, causing coronary blood flow velocity reserve to decrease to 50% of baseline.
- Complete revascularization of the circumflex lesion barely reversed the hemodynamic deficit, confirming collateral vessels as the underlying source of the steal.
Structured PICO
PPopulation1 patient with a well collateralised coronary vascular area supplied by a reopened left circumflex coronary artery
IInterventionAdenosine-induced hyperemia assessed by intravascular Doppler guidewire
CComparatorBaseline conditions
OOutcomeDetection of steal phenomenon and change in blood flow velocity reservesurrogate
Demonstrates in vivo that coronary collaterals can cause an adenosine-induced steal phenomenon, reducing blood flow velocity reserve.