Angiographic Variants of Collateral Blood Flow and Their Significance in Recanalization of Chronic Total Occlusions

The aim of the investigation was to classify the variants of angiographic collateral blood flow in postocclusal segments of coronary arteries, and to determine the significance of each of them in achieving successful endovascular recanalization of coronary chronic total occlusion (CTO).

Materials and Methods. The study involved 128 patients (105 males and 23 females), with a mean age of 56.0±0.6 years. Between 2009 and 2011 the patients underwent endovascular intervention for CTO in the Specialized Cardiovascular Clinical Hospital, Nizhny Novgorod. Stable FC II–III angina (NYHA) had been diagnosed in all patients. The anterior descending artery was occluded in 39% of cases, the anterior coronary artery — in 41% of cases, and the circumflex artery — in 8% of cases, while, in all other cases, lateral branches were involved. The mean occlusion duration was 41.0±4.3 months (from 3 months to 20 years). The lengths of the occlusions ranged from 4 to 50 mm. According to the J-CTO scale, 47% cases had mild occlusions, 32% — moderately severe, and 21% — severe or very severe occlusions. All patients underwent CTO recanalization using endovascular antegrade techniques.

Results. Based on the findings of selective coronography of the CTO patients we distinguished angiographic variants showing different types of collateral blood flow in the postocclusal segments of the coronary arteries, and established a significant dependence of the success of recanalization on the type of collateral blood flow seen in the postocclusal segments. For example: where the type of blood flow can be classified as RAI-III or RAI-Iа, an intervention is more frequently successful than with the other types. In antegrade mechanical recanalization, it is collateral blood flow of type RAI-Ib which results in fewer positive results.

Conclusion. The RAI classification which we have established can be recommended as an option for the systematization of angiographic manifestations of collateral blood. This is of great practical importance, since it enables assessment of the extent of a lesion and the selection of an interventional correction technique.

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Ryazhskikh А.I., Shakhov B.Е. Angiographic Variants of Collateral Blood Flow and Their Significance in Recanalization of Chronic Total Occlusions. Sovremennye tehnologii v medicine 2014; 6(4): 182