Prevalence of Extracardiac Coronary Collateral Supply Via the Internal Mammary Arteries

NCT01676207 | Completed

• 1 other identifier: 007/12
• Study Type: observational
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

In contrast to the extensively studied coronary collateral circulation within the heart, clinical attention has been paid only anecdotally to extracardiac-to-coronary anastomoses. Usually this has been in the form of case reports giving account of angiographically visible anastomoses between the coronary circulation and the internal mammary artery (IMA), typically in the presence of a chronic occlusion of a coronary artery. In the anatomical literature,the most common types of extracardiac anastomoses include bronchial-to-coronary-artery and IMA-to-coronary-artery connections. Anastomoses between the IMA and the coronary circulation have been documented to occur in 12% of post-mortem patients with CAD. Importantly, hitherto existing observations typically have relied on visual methods insensitive for the adequate detection especially of structurally present but poorly functional anastomoses. On a diagnostic coronary angiogram, collaterals are visible only if the recipient vessel is subtotally stenotic or fully occluded, or can be rendered visible during coronary spasm or by temporary balloon occlusion of the recipient artery and simultaneous injection of contrast medium into the other arteries, respectively. Similarly, the macroscopic pathologic postmortem examination is likely to underestimate the true number of extracardiac coronary collaterals. The purpose of this study is to determine the in vivo prevalence and functional distribution of IMA-to-coronary collateral supply via both the right and the left coronary artery.

Conditions

Coronary Artery Disease; Collateral Circulation; Ischemia

Keywords

coronary collateral circulation; extracardiac coronary collaterals; coronary artery disease; coronary circulation; internal mammary artery

Outcome Measures

Primary Outcomes (1)

• Coronary Collateral Flow Index (CFI)

  during coronary artery balloon occlusion

Secondary Outcomes (2)

• Intra-coronary occlusive ECG ST segment shift (mV)

  at 1 minute of coronary artery balloon occlusion

• angiographic visibility of coronary collateral supply via the internal mammary artery during their distal balloon occlusion

  at 1 minute of coronary artery balloon occlusion

Study Arms (2)

1

CAD

Procedure: Coronary Angiography with collateral flow measurements

2

no CAD

Procedure: Coronary Angiography with collateral flow measurements

Interventions

Coronary Angiography with collateral flow measurements PROCEDURE

* Diagnostic coronary angiography and LV angiography * Administration of 5'000 units of heparin i.v. and 2 puffs of oral isosorbide-dinitrate * Right and left IMA CFI during a 1-minute ostial vessel occlusion * Selection of the coronary artery for CFI according to stenotic lesion chosen for PCI or according to ease of access by the pressure sensor wire. Placement of a non-sensor wire in the left IMA. Two coronary CFI measurements (1-minute occlusion): the first with, the second without distal IMA balloon occlusion. Placement of a non-sensor wire in the right IMA. Two coronary CFI measurements: the first with, the second without distal IMA balloon occlusion. * IMA angiography (left and right) during distal IMA and coronary occlusion.

1

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients electively referred for coronary angiography

You may qualify if:

• age \> 17 years
• electively referred for coronary angiography
• written informed consent to participate in the study

You may not qualify if:

• Acute coronary syndrome
• Prior coronary artery bypass grafting
• Severe cardiac valve disease
• Congestive heart failure NYHA III-IV
• Severe pulmonary artery hypertension
• Severe hepatic or renal failure (creatinine clearance \< 15ml/min)

Sponsors & Collaborators

• Insel Gruppe AG, University Hospital Bern: lead

Study Sites (1)

Department of Cardiology, Bern University Hospital

Bern, 3010, Switzerland

Location

Related Publications (1)

• Stoller M, de Marchi SF, Seiler C. Function of natural internal mammary-to-coronary artery bypasses and its effect on myocardial ischemia. Circulation. 2014 Jun 24;129(25):2645-52. doi: 10.1161/CIRCULATIONAHA.114.008898. Epub 2014 Apr 17.

  PMID: 24744276 DERIVED

MeSH Terms

Conditions

Coronary Artery Disease; Ischemia

Condition Hierarchy (Ancestors)

Coronary Disease; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Christian Seiler, MD Prof

  Department of Cardiology, Bern University Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 28, 2012
• First Posted: August 30, 2012
• Study Start: July 1, 2012
• Primary Completion: December 1, 2013
• Study Completion: December 1, 2013
• Last Updated: January 16, 2014

Record last verified: 2014-01

Locations

CH (1)