Prevalence of Extracardiac Coronary Collateral Supply Via the Internal Mammary Arteries

Summary

In contrast to the extensively studied coronary collateral circulation within the heart, clinical attention has been paid only anecdotally to extracardiac-to-coronary anastomoses. Usually this has been in the form of case reports giving account of angiographically visible anastomoses between the coronary circulation and the internal mammary artery (IMA), typically in the presence of a chronic occlusion of a coronary artery. In the anatomical literature,the most common types of extracardiac anastomoses include bronchial-to-coronary-artery and IMA-to-coronary-artery connections. Anastomoses between the IMA and the coronary circulation have been documented to occur in 12% of post-mortem patients with CAD.

Importantly, hitherto existing observations typically have relied on visual methods insensitive for the adequate detection especially of structurally present but poorly functional anastomoses. On a diagnostic coronary angiogram, collaterals are visible only if the recipient vessel is subtotally stenotic or fully occluded, or can be rendered visible during coronary spasm or by temporary balloon occlusion of the recipient artery and simultaneous injection of contrast medium into the other arteries, respectively. Similarly, the macroscopic pathologic postmortem examination is likely to underestimate the true number of extracardiac coronary collaterals.

The purpose of this study is to determine the in vivo prevalence and functional distribution of IMA-to-coronary collateral supply via both the right and the left coronary artery.

Conditions

• Coronary Artery Disease
• Collateral Circulation
• Ischemia

Interventions

PROCEDURE

Coronary Angiography with collateral flow measurements

* Diagnostic coronary angiography and LV angiography * Administration of 5'000 units of heparin i.v. and 2 puffs of oral isosorbide-dinitrate * Right and left IMA CFI during a 1-minute ostial vessel occlusion * Selection of the coronary artery for CFI according to stenotic lesion chosen for PCI or according to ease of access by the pressure sensor wire. Placement of a non-sensor wire in the left IMA. Two coronary CFI measurements (1-minute occlusion): the first with, the second without distal IMA balloon occlusion. Placement of a non-sensor wire in the right IMA. Two coronary CFI measurements: the first with, the second without distal IMA balloon occlusion. * IMA angiography (left and right) during distal IMA and coronary occlusion.

PROCEDURE

Coronary Angiography with collateral flow measurements

* Diagnostic coronary angiography and LV angiography * Administration of 5'000 units of heparin i.v. and 2 puffs of oral isosorbide-dinitrate * Right and left IMA CFI during a 1-minute ostial vessel occlusion * Selection of the coronary artery for CFI according to stenotic lesion chosen for PCI or according to ease of access by the pressure sensor wire. Placement of a non-sensor wire in the left IMA. Two coronary CFI measurements (1-minute occlusion): the first with, the second without distal IMA balloon occlusion. Placement of a non-sensor wire in the right IMA. Two coronary CFI measurements: the first with, the second without distal IMA balloon occlusion. * IMA angiography (left and right) during distal IMA and coronary occlusion.

Sponsors & Collaborators

• Insel Gruppe AG, University Hospital Bern

  lead OTHER

Principal Investigators

• Christian Seiler, MD Prof · Department of Cardiology, Bern University Hospital

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2012-07-31

Primary Completion

2013-12-31

Completion

2013-12-31

Countries

• Switzerland

Study Locations