scholarly journals Effect of Revascularization of Chronic Total Occlusion on Tandem Stenoses in a “Donor” Artery

2014 ◽  
Vol 41 (5) ◽  
pp. 547-550 ◽  
Author(s):  
Rajesh Sachdeva
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Myocardial Segment ◽  
Fractional Flow ◽  
Total Occlusion ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Donor Artery ◽  
Artery Disease

The presence, severity, and extent of ischemia predict the outcome of coronary artery disease. Indeed the extent of myocardial ischemia and viability determines the value of revascularization in coronary stenosis after acute myocardial infarction. In multivessel coronary artery disease, noninvasive methods for the evaluation of ischemia are often inadequate to guide percutaneous coronary intervention. It is a common misperception that revascularization might not benefit a myocardial segment in the chronic total occlusion distribution when that segment is supplied by well-developed collateral vessels, because severe ischemia is unlikely to be present under these circumstances. An 82-year-old man presented with acute coronary syndrome, tandem stenoses in a “donor” artery, and a chronic total occlusion of the right coronary artery. We present a rationale for using fractional flow reserve to determine the existence of ischemia and to aid in deciding the best approach to the treatment of that ischemia.

Recent advances in the role of the adenosinergic system in coronary artery disease

2020 ◽  
Author(s):  
Franck Paganelli ◽  
Marine Gaudry ◽  
Jean Ruf ◽  
Régis Guieu
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Tissue Hypoxia ◽  
Exercise Stress ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Artery Disease

Abstract Adenosine is an endogenous nucleoside that plays a major role in the physiology and physiopathology of the coronary artery system, mainly by activating its A2A receptors (A2AR). Adenosine is released by myocardial, endothelial, and immune cells during hypoxia, ischaemia, or inflammation, each condition being present in coronary artery disease (CAD). While activation of A2AR improves coronary blood circulation and leads to anti-inflammatory effects, down-regulation of A2AR has many deleterious effects during CAD. A decrease in the level and/or activity of A2AR leads to: (i) lack of vasodilation, which decreases blood flow, leading to a decrease in myocardial oxygenation and tissue hypoxia; (ii) an increase in the immune response, favouring inflammation; and (iii) platelet aggregation, which therefore participates, in part, in the formation of a fibrin-platelet thrombus after the rupture or erosion of the plaque, leading to the occurrence of acute coronary syndrome. Inflammation contributes to the development of atherosclerosis, leading to myocardial ischaemia, which in turn leads to tissue hypoxia. Therefore, a vicious circle is created that maintains and aggravates CAD. In some cases, studying the adenosinergic profile can help assess the severity of CAD. In fact, inducible ischaemia in CAD patients, as assessed by exercise stress test or fractional flow reserve, is associated with the presence of a reserve of A2AR called spare receptors. The purpose of this review is to present emerging experimental evidence supporting the existence of this adaptive adenosinergic response to ischaemia or inflammation in CAD. We believe that we have achieved a breakthrough in the understanding and modelling of spare A2AR, based upon a new concept allowing for a new and non-invasive CAD management.

scholarly journals Coronary physiology before and after chronic total occlusion treatment: what does it tell us?

2020 ◽  
Vol 29 (1) ◽  
pp. 22-29 ◽  
Author(s):  
D. C. J. Keulards ◽  
P. J. Vlaar ◽  
I. Wijnbergen ◽  
N. H. J. Pijls ◽  
K. Teeuwen
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Total Occlusion ◽  
Flow Reserve ◽  
Donor Artery ◽  
Before And After ◽  
Over Time

AbstractStudies performed in the last two decades demonstrate that after successful percutaneous coronary intervention (PCI) of a chronically occluded coronary artery, the physiology of the chronic total occlusion (CTO) vessel and dependent microvasculature does not normalise immediately but improves significantly over time. Generally, there is an increase in fractional flow reserve (FFR) in the CTO artery, a decrease in collateral blood supply and an increase in FFR in the donor artery accompanied by an increase in blood flow and decrease in microvascular resistance in the myocardium supplied by the CTO vessel. Analogous to these physiological changes, positive remodelling of the distal CTO artery also occurs over time, and intravascular imaging can be helpful for analysing distal vessel parameters. Follow-up coronary angiography with physiological measurements after several weeks to months can be helpful and informative in a subset of patients in order to decide upon the necessity for treatment of residual coronary artery stenosis in the vessel distal to the CTO or in the contralateral donor artery, as well as in deciding whether stent optimisation is indicated. We suggest that such physiological guidance of CTO procedures avoids unnecessary overtreatment during the initial procedure, guides interventions at follow-up, and improves our understanding of what PCI in CTO means.

scholarly journals Acute Coronary Syndrome and Arrhytmia Induced by SARS-CoV-2 Infection in a Patient with Non-Significant LAD Lesion. A Case Report

2021 ◽  
Vol 6 (1) ◽  
pp. 43-47
Author(s):  
Péter Balázs Oltean ◽  
István Kovács ◽  
Roxana Hodas ◽  
Nora Rat ◽  
Theodora Benedek
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Subsequent Development ◽  
Fractional Flow ◽  
Infectious Episode ◽  
Health Crisis ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Artery Disease

Abstract Background: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis of an unprecedent effect. Clinical studies reported an association between COVID-19 and cardiovascular disease, whereas COVID-19 itself can induce myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. Case summary: A patient diagnosed via screening coronary computed tomography angiography with non-obstructive coronary artery disease was hospitalized with non-ST elevation myocardial infarction and atrial flutter during a severe respiratory infection episode with SARS-CoV-2. After recovery from the infectious episode, fractional flow reserve-guided elective percutaneous coronary intervention with drug-eluting stent was performed. Conclusions: COVID-19 intercurrence in a cardiovascular patient with nonobstructive coronary artery disease triggered coronary plaque vulnerabilization with subsequent development of an acute coronary syndrome. SARS-CoV-2 proved to be involved via direct viral tissue involvement and concomitant mechanisms derived from systemic illness in the development of a severe supraventricular arrhythmic event.

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