Fate of Collateral Vessels After Successful Coronary Angioplasty in Patients With Effort Angin

Objectives. The purpose of the present study was to evaluate whether severe restenosis after percutaneous transluminal coronary angioplasty (PTCA) promotes collateral development and whether successful dilation regresses collateral vessels. Background. It is well known that in the presence of severe coronary stenosis, native collateral arterioles mature to small coronary arteries with several layers of smooth muscle cells. However, it remains unclear whether well developed collateral vessels regress after removal of coronary stenosis. Methods. The study group comprised 41 patients who underwent elective PTC for effort angin due to single-vessel disease, followed by repeat PTC to treat restenosis. We classified the patients into three groups depending on the change in baseline Thrombolysis in Myocardial Infarction (TIMI) flow grade of the ischemia-related artery at initial and repeat PTCA, and we compared the extent of ST segment elevation at 1 min of the first balloon inflation between the two procedures. The average interval from initial to repeat PTC was 125 days. Results. The three patient groups comprised group A, 12 patients with decreased flow grade because of severe coronary restenosis; group B, 12 patients with increased flow grade who had severe initial stenosis and relatively mild restenosis; and group C, 17 patients with unchanged flow grade. In the presence of comparable rate-pressure products at initial and repeat PTCA, patients in group had significantly greater ST segment elevation (p < 0.01) at initial than at repeat PTC (mean ± SD 0.42 ± 0.31 vs. 0.13 ± 0.22 mV). In group B, ST segment elevation was significantly less at initial than at repeat PTC (0.13 ± 0.25 vs. 0.19 ± 0.17 mV, p < 0.05), and in group C, it was comparable at the two procedures (0.37 ± 0.32 vs. 0.35 ± 0.33 mV, p = 0.50). Conclusions. These findings indicate that severe restenosis after PTC promotes collateral development and that successful dilation regresses collateral vessels during relatively short period of time.