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Influence of Angiographic Collateral Circulation on Myocardial Perfusion in Patients with Chronic Total Occlusion of a Single Coronary Artery and No Prior Myocardial Infarction

¹ Division of Nuclear Medicine, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
² Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
³ Department of Medicine, School of Medicine, University of California, Los Angeles, California

The functional role of various angiographic grades for coronary collaterals remains controversial. The aim of this study was to assess the influence of the Rentrop angiographic grading of coronary collaterals on myocardial perfusion in patients with single-vessel chronic total occlusion (CTO) and no prior myocardial infarction (MI). Methods: The study included 56 patients with single-vessel CTO and no prior MI who underwent rest–stress myocardial perfusion SPECT and coronary angiography within 6 mo. All patients had angiographic evidence of coronary collaterals. Patients were divided according to the Rentrop classification: Group I had grade 1 or 2 (n = 25) and group II had grade 3 collaterals (n = 31). Results: Group I had a higher frequency of resting regional wall motion abnormalities on left ventriculography (52.6% vs. 19.2% [P = 0.019]). The mean perfusion scores of the overall population showed severe and extensive stress perfusion defects (summed stress score of 14.1 ± 7.1 and summed difference score of 12.9 ± 6.9) but minimal resting perfusion defects (summed rest score of 1.0 ± 2.7). No perfusion scores differed between the 2 groups. The perfusion findings suggested that chronic stunning rather than hibernation is the principal cause of regional wall motion abnormalities in these patients. Conclusion: In the setting of single-vessel CTO and no prior MI, coronary collaterals appear to protect against resting perfusion defects. Excellent angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defects.

Key Words: collaterals • myocardial perfusion SPECT • chronic total occlusion

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