Authors
Mohammed Salih, Amr Marawan, Ahmed Kazem, Abdallah Assaf, Mohamad Bader Abo Hajar, Imran Baig, Jared L Christensen, Dinesh Reddy Apala, Karthik Anand, Michael Megaly, Salman Allana, Srinivasa Potluri, Karim Al-Azizi
Published in
Proceedings (Baylor University. Medical Center). Pages 1-9. Oct 12, 2026. Epub Oct 12, 2026.
Abstract
In chronic total occlusion (CTO), donor vessels supplying collateral flow to the occluded artery may exhibit altered physiological indices, potentially influencing revascularization decisions. This case series evaluates the impact of successful CTO percutaneous coronary intervention (PCI) on instantaneous wave-free ratio (iFR) measurements in donor vessels with moderate stenosis.
We present a single-center case series (December 2020-September 2024) involving five patients with right coronary artery (RCA) CTO and a moderately diseased mid-left anterior descending artery (LAD) functioning as a collateral donor. All patients underwent ischemia testing and successful RCA CTO PCI. LAD iFR was measured before and after RCA revascularization.
Pre-PCI LAD iFR values ranged from 0.73 to 0.89, at or below the ischemic threshold. Post-RCA-PCI iFR improved in all cases (range: 0.87-0.96): in case 1, from 0.82 to 0.93; in case 2, from 0.82 to 0.89; in case 3, from 0.87 to 0.96; in case 4, from 0.73 to 0.87; and in case 5, from 0.89 to 0.96. In all cases, intervention on the LAD was deferred post-PCI, with no adverse clinical events during follow-up.
Successful RCA CTO PCI leads to immediate improvement in donor vessel iFR, suggesting that collateral demand may exaggerate ischemia. Staged physiologic assessment may improve decision-making in patients with moderate lesions in donor vessels.
PMID:
42862595
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.
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