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Myocardial Perfusion in Patients With a Totally Occluded Left Anterior Descending Coronary Artery Reinjected by a Normal Right Coronary Artery: The Role of Collateral Circulation

Department of Cardiology, Clemenceau Medical Center, elie.chammas{at}cmc.com.lb

Ayman Hussein, MD

Department of Internal Medicine, American University of Beirut Medical Center, Lebanese University campus, Hadath Lebanon

Ghada Ballane, MD

Department of Internal Medicine, American University of Beirut Medical Center, Lebanese University campus, Hadath Lebanon

Antoine Helou, MD

Department of Internal Medicine, American University of Beirut Medical Center, Lebanese University campus, Hadath Lebanon

Ahmad Yatim, MD

Rizk Hospital Beirut

Walid Tarcha, MD

Rizk Hospital Beirut

Georges Ghanem, MD

Rizk Hospital Beirut

In this article, myocardial perfusion in patients with a totally occluded left anterior descending artery reinjected by a normal right coronary artery is assessed using stress single photon emission computed tomography (SPECT). In all, 20 patients, with a totally occluded left anterior descending artery reinjected by normal right coronary artery, underwent myocardial single photon emission computed tomography imaging within 60 days of angiography. All patients had abnormal perfusion single photon emission computed tomography results and 70% had reversible defects. Perfusion defects at rest were present in 75% of patients, with perinecrotic residual ischemia in 45% of patients whereas for 30% of patients, no viable myocardium was detected in the collateral-dependent segments. In all, 25% of patients had no resting perfusion defects but all are presented with stress-induced ischemia. Collaterals are not protective against stress-induced ischemia, but they can preserve myocardial viability. This conclusion is highly supported by the presence of residual ischemia in the collateral-dependent segments.

Key Words: collateral circulation • myocardial perfusion • SPECT • total LAD occlusion

This version was published on August 1, 2008

Angiology, Vol. 59, No. 4, 464-468 (2008)
DOI: 10.1177/0003319707309308


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