Stress perfusion cardiovascular magnetic resonance and serial fractional flow reserve assessment of the left anterior descending artery in patients undergoing right coronary artery chronic total occlusion revascularization

OBJECTIVE: This study applied pressure measurement to measure the hemodynamic changes in right coronary artery (RCA) donor vessels before and after the opening of the vessel in patients with left anterior descending chronic total occlusion (LAD-CTO) interventional therapy. METHODS: A total of 45 patients with LAD-CTO were divided into two groups of percutaneous coronary intervention (PCI) to observe the hemodynamic changes (fractional flow reserve [FFR] and instantaneous wave-free ratio [iFR]) before and after opening the chronic total occlusion (CTO), in order to provide collateral circulating donor vessels to the CTO, and observe the changes in iFR and FFR. The results of these two measures were compared to determine the significance of the donor vascular function. RESULTS: A total of 45 patients with LAD-CTO successfully underwent LAD-CTO interventional therapy, and were immediately measured for FFR and iFR of the donor vessels. The FFR changes before right coronary artery flow reserve (RCAFR) was 0.73±0.083, and after the operation, this was 0.77±0.073. The iFR changes before RCAFR was 0.90±0.048, and after the operation, this was 0.93±0.034. Before and after the opening of the RCA, the FFR change (ΔFFR) and iFR change (ΔiFR) were also correlated with r = 0.033 (0.041–0.568: P < 0.05). A total of 19 cases had a FFR value of <0.75 before the operation, and the average FFR before and after the PCI was 0.65±0.048 and 0.72±0.057, respectively. Furthermore, the ΔFFR was 0.076±0.057 (n = 19), and FFR was >0.75 in 26 cases. The ΔFFR was 0.017±0.0088 (n = 26). These two groups were compared, P = 0.0032 (P < 0.05). CONCLUSION: The FFR and iFR results were the same in terms of RCA hemodynamic changes, after the LAD-CTO was opened. For the RCA with a preoperative FFR of <0.75, the increase in RCAFR after LAD-CTO PCI was more obvious.

Download Full-text

Perfusion cardiovascular magnetic resonance and fractional flow reserve in patients with angiographic multi-vessel coronary artery disease

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-016-0263-0 ◽

2016 ◽

Vol 18 (1) ◽

Cited By ~ 12

Author(s):

Shazia T. Hussain ◽

Amedeo Chiribiri ◽

Geraint Morton ◽

Nuno Bettencourt ◽

Andreas Schuster ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cardiovascular Magnetic Resonance ◽

Coronary Artery ◽

Magnetic Resonance ◽

Fractional Flow Reserve ◽

Fractional Flow ◽

Vessel Coronary Artery Disease ◽

Flow Reserve ◽

Artery Disease ◽

Vessel Coronary Artery

Download Full-text

Interventricular Septal Hematoma after Retrograde Intervention for a Chronic Total Occlusion of a Right Coronary Artery: Echocardiographic and Magnetic Resonance Imaging—Diagnosis and Follow-Up

Case Reports in Medicine ◽

10.1155/2016/8514068 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Makoto Araki ◽

Tadashi Murai ◽

Yoshihisa Kanaji ◽

Junji Matsuda ◽

Eisuke Usui ◽

...

Keyword(s):

Coronary Artery ◽

Magnetic Resonance ◽

Right Coronary Artery ◽

Chronic Total Occlusion ◽

Rare Complication ◽

Interventricular Septum ◽

Success Rates ◽

Retrograde Approach ◽

Total Occlusion

The reverse CART technique provides the potential to modify the retrograde procedure by improving the controlled movement of the retrograde wire and improve the success rates of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Development of interventricular hematoma is a rare complication of CTO PCI. A 63-year-old man with effort angina with a right coronary artery CTO lesion underwent PCI by retrograde approach from the LAD to a septal branch. A contrast “stain” was demonstrated surrounding the septal collateral channel used for the retrograde approach at the end of the procedure without symptom. Echocardiography indicated an increased interventricular septum thickness with low echo signals region and decreased contractility. Cardiac magnetic resonance (CMR) imaging using gadolinium showed a diffusely thickened septum with a low signal fusiform neocavitation delimited by an enhanced-signal ring suggesting intraventricular septal dissecting hematoma. After conservative treatment, follow-up echocardiogram and CMR showed the resolution of the hematoma without clinical events. This case highlights the potentially lethal complication of septal perforator dissection and hematoma that may cause severe myocardial injury caused by retrograde approach for CTO PCI.

Download Full-text