Applicability and Interpretation of Coronary Physiology in the Setting of a Chronic Total Occlusion

Usaid K. Allahwala, Emmanouil S Brilakis, Jonathan Byrne, Justin E. Davies, Michael R. Ward, James C. Weaver, Ravinay Bhindi

Research output: Contribution to journalArticle

Abstract

Concurrent coronary artery disease in a vessel remote from a chronic total occlusion (CTO) is common and presents a management dilemma. While the use of adjunctive coronary physiology to guide revascularization is now commonplace in the catheterization laboratory, the presence of a CTO provides a unique and specific situation whereby the physiological assessment is more complex and relies on theoretical assumptions. Broadly, the physiological assessment of a CTO relies on assessing the function and regression of collaterals, the assessment of the microcirculation, the impact of collateral steal as well as assessing the severity of a lesion in the donor vessel (the vessel supplying the majority of collaterals to the CTO). Recent studies have shown that physiological assessment of the donor vessel in the setting of a CTO may overestimate the severity of stenosis, and that after revascularization of a CTO, the index of ischemia may increase, potentially altering the need for revascularization. In this review article, we present the current literature on physiological assessment of patients with a CTO, management recommendations and identify areas for ongoing research.

Original languageEnglish (US)
Pages (from-to)e007813
JournalCirculation. Cardiovascular interventions
Volume12
Issue number7
DOIs
StatePublished - Jul 1 2019

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Tissue Donors
Microcirculation
Catheterization
Coronary Artery Disease
Pathologic Constriction
Ischemia
Research

Keywords

  • catheterization
  • incidence
  • microcirculation
  • myocardial infarction
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Applicability and Interpretation of Coronary Physiology in the Setting of a Chronic Total Occlusion. / Allahwala, Usaid K.; Brilakis, Emmanouil S; Byrne, Jonathan; Davies, Justin E.; Ward, Michael R.; Weaver, James C.; Bhindi, Ravinay.

In: Circulation. Cardiovascular interventions, Vol. 12, No. 7, 01.07.2019, p. e007813.

Research output: Contribution to journalArticle

Allahwala, Usaid K. ; Brilakis, Emmanouil S ; Byrne, Jonathan ; Davies, Justin E. ; Ward, Michael R. ; Weaver, James C. ; Bhindi, Ravinay. / Applicability and Interpretation of Coronary Physiology in the Setting of a Chronic Total Occlusion. In: Circulation. Cardiovascular interventions. 2019 ; Vol. 12, No. 7. pp. e007813.
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