Collateral Circulation In Patients Research Articles

Association between the atherogenic index of plasma and coronary collateral circulation in patients with chronic total occlusion

BackgroundThe atherogenic index of plasma (AIP) is considered an independent risk factor for coronary artery disease (CAD). The present study investigated whether AIP correlates with the formation of coronary collateral circulation (CCC) in CAD patients with chronic total occlusion (CTO).MethodsThis retrospective study included 1093 CAD patients with CTO confirmed by coronary angiography from January 2020 to December 2020 at Beijing Anzhen Hospital. Based on the Rentrop scoring system, the patients were divided into the good CCC group and the poor CCC group. AIP was calculated by log (triglyceride/high-density lipoprotein cholesterol). Meanwhile, the study population was further divided into four groups according to the quartiles of AIP.ResultsPatients in the poor CCC group exhibited significantly higher AIP compared to those in the good CCC group (0.31 ± 0.27 vs. 0.14 ± 0.24, p < 0.001). Multivariate logistic regression analysis revealed an independent association between AIP and poor CCC, regardless of whether AIP was treated as a continuous or categorical variable (p < 0.001), after adjusting for confounding factors. Besides, this association remained consistent across most subgroups. The incorporation of AIP into the baseline model significantly enhanced the accuracy of identifying poor CCC [area under the curve (AUC): baseline model, 0.661 vs. baseline model + AIP, 0.721, p for comparison < 0.001].ConclusionsElevated AIP is independently associated with an increased risk of poor CCC in CAD patients with CTO, and AIP may improve the ability to identify poor CCC in clinical practice.

Albumin levels and cerebral collateral circulation in patients with acute ischemic stroke due to intracranial arteriosclerotic: A propensity score-matched analysis.

Cerebral collateral circulation (CC) is associated with the recurrence and severity of acute ischemic stroke (AIS), and early identification of poor CC is helpful for the prevention of AIS. In this study we evaluated the association between serum albumin levels and CC in AIS using logistic regression. Propensity score (PS) matching was used to eliminate the effect of confounders, and restricted cubic splines (RCS) were employed to explore potential nonlinear associations between albumin and CC. In unadjusted logistic regression analysis, lower albumin (OR = 0.85, 95% CI = 0.79-0.92) was associated with poor CC, and after adjusting for covariates, the odds of lower albumin for poor CC compared to good CC were 0.86 (95% CI = 0.79-0.94). In the PS cohort, the association of albumin with CC was consistent with those of the original cohort. RCS results showed a linear relationship between albumin and CC (P values of .006 and .08 for overall and nonlinear associations, respectively). The results of this study suggest that lower serum albumin is independently associated with an increased risk of poor CC, which may serve as an effective predictive indicator for poor CC in patients with severe intracranial atherosclerotic stenosis.

Correlation between insulin resistance and coronary collateral circulation in patients with chronic total coronary occlusion

To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism. This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis. NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways. The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.

Correlation between triglyceride glucose index and collateral circulation formation in patients with chronic total occlusion of coronary arteries in different glucose metabolic states

BackgroundTo investigate the correlation between triglyceride glucose index (TyG) and collateral circulation in patients with chronic total occlusion (CTO) of coronary arteries in different glucose metabolic states.MethodsA total of 681 patients who underwent coronary angiography between January 2020 and December 2021 to determine the presence of CTO lesions in at least one major coronary artery were retrospectively included in this study. Patients were categorized into a group with poor collateral circulation formation (Rentrop grade 0–1, n = 205) and a group with good collateral circulation formation (Rentrop grade 2–3, n = 476) according to the Rentrop scale. They were also categorized according to their glucose metabolism status: normal glucose regulation (NGR) (n = 139), prediabetes mellitus (Pre-DM) (n = 218), and diabetes mellitus (DM) (n = 324). Correlation between TyG index and collateral circulation formation was analyzed by logistic regression analysis and receiver operating characteristic (ROC) curves.ResultsAmong patients with CTO, TyG index was significantly higher in the group with poor collateral circulation formation than in the group with good collateral circulation formation. Logistic regression analysis showed that TyG index was an independent risk factor for poor collateral circulation formation (OR 5.104, 95% CI 3.323–7.839, P < 0.001). The accuracy of TyG index in predicting collateral circulation formation was evaluated by the ROC curve, which had an area under the curve of 0.779 (95% CI 0.738–0.820, P < 0.001). The restrictive cubic spline curves showed that the risk of poor collateral circulation formation in the Pre-DM and DM groups was initially flat and finally increased rapidly, except for the NGR group. TyG index was significantly associated with an increased risk of poor collateral circulation formation in the Pre-DM and DM groups.ConclusionsTyG index was significantly associated with the risk of poor collateral circulation formation in patients with CTO, especially those with Pre-DM and DM.

Assessment of Collateral Pathways in Carotid Occlusion: Investigating the Clinical Significance of Ultrasound and TCCS

Background: Carotid occlusion is a severe condition closely associated with ischemic stroke. The prompt identification of patients presenting with extracranial carotid artery occlusion and the evaluation of collateral circulation compensation in these individuals bear significant clinical importance for subsequent patient management. Ultrasound offers significant advantages in the diagnosis of extracranial carotid artery stenosis and occlusion, while Transcranial Color-Coded Sonography (TCCS) is increasingly pivotal in assessing intracranial artery stenosis and determining blood flow direction. The objective of our study was to assess the concordance between ultrasound combined with TCCS and digital subtraction angiography (DSA) in evaluating extracranial carotid occlusion and intracranial collateral circulation.&#x0D; Methods: Patients with severe stenosis in the extracranial carotid artery were recruited for our study. All patients suspected of having occlusion in the extracranial carotid arteries underwent ultrasound, transcranial color-coded sonography (TCCS), and digital subtraction angiography (DSA). Sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, and kappa value were employed to assess the effectiveness and consistency of ultrasound and TCCS compared to DSA.&#x0D; Results: Ultrasound demonstrated a sensitivity of 85.4%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.4%, and overall accuracy of 93.9% in the diagnosis of extracranial artery occlusion. The kappa value was calculated as 0.87 (P＜0.001), indicating substantial agreement between ultrasound and DSA measurements for consistency assessment. Transcranial color-coded sonography (TCCS) exhibited a sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 97.6%, 100%, 100%, 66.7%, and 97.7% respectively in evaluating collateral circulation in patients with carotid artery occlusion. The kappa value was 0.79 (P＜0.001) in assessing the collateral circulation in patients with occluded carotid arteries.&#x0D; Conclusions: Ultrasound proved to be a valuable tool for evaluating patients with occluded carotid arteries, while TCCS emerged as a reliable approach for assessing collateral pathways in individuals with extracranial carotid artery occlusion.

Retracted: The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease

Retracted: The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease

Effect of collateral circulation in patients with multiple craniocervical artery stenoses.

Based on previous findings, collateral circulation in the brain is vital in mitigating cerebral ischemia's effects and influencing stroke risk. This retrospective study examined collateral circulation, admission ischemic stroke status, and long-term recurrence in patients with multiple craniocervical artery stenoses. Consecutive symptomatic internal carotid artery (ICA) stenosis patients from the First Affiliated Hospital of Soochow University were recruited. Baseline data including medical histories and neurological function at admission were collected. Imaging techniques assessed collateral compensative capacity. Multivariate logistic regression analysis was used to investigate the association between collateral circulation and case status. A total of 559 patients with symptomatic ICA stenosis were included, among whom 153 (27.4%) had concurrent moderate to severe vertebro-basilar artery (VBA) stenosis. Dizziness, weakness/numbness, and slurring of speech were the primary symptoms in all patients. Over 36 months, 71 (12.7%) patients experienced a recurrence of acute ischemic stroke (AIS). In multivariate analysis, collateral circulation was found to be negatively associated with AIS (regional leptomeningeal collateral [rLMC] scores: OR: 0.798, 95% CI: 0.743-0.857, p < 0.001; Tan scores: OR: 0.478, 95% CI: 0.336-0.679, p < 0.001). Meanwhile, the collateral circulation scores were significantly associated with the recurrence of AIS within 3 years (rLMC scores: OR: 0.926, 95% CI: 0.860-0.997, p = 0.042; Tan scores: OR: 0.467, 95% CI: 0.306-0.712, p < 0.001). Most associations remained significant in the subgroup of patients with VBA stenosis. Favorable collateral circulation in multiple craniocervical artery stenosis patients reduced long-term ischemic event recurrence. Stratifying treatment risks is essential for optimizing outcomes.

Are Thiols Useful Biomarkers for Coronary Collateral Circulation in Patients with Stable Coronary Artery Disease?

Our aim was to investigate the relationship between thiol, which is the main component of the antioxidant system, and coronary collateral circulation (CCC). Our patients consisted of people with stable coronary artery disease (sCAD) and total occlusion in at least one vessel (n = 249). We divided the patients into two groups, good and poor, according to their CCC degree. We determined that DM, total thiol, and disulfide are independent predictors of poor CCC in multivariate logistic regression analysis (OR: 1.012, 95% CI: 1.008-1.017, p < 0.001; OR: 1.022, 95% CI: 1.000-1.044, p = 0.044; OR: 2.671, 95% CI: 1.238-5.761, p = 0.012, respectively). The ROC analysis showed a cut-off value of 328.7 for native thiol regarding the prediction of poor CCC, with 67.4% specificity and 78% sensitivity. For disulfide, it revealed a cut-off value of 15.1 regarding the prediction of poor CCC, with 57.9% specificity and 69.5% sensitivity. In this study, we detected that the patients with sCAD who developed poor CCC had lower levels of native thiol, total thiol, and disulfide compared to those with good CCC. The most interesting finding of our study is that CCC formation is an effective predictor of the antioxidant cascade rather than the inflammation cascade in sCAD patients.

Role of circulating CD14++CD16+ monocytes and VEGF-B186 in formation of collateral circulation in patients with hyperacute AMI

IntroductionCollateral formation is insufficient in some patients with acute myocardial infarction (AMI). Peripheral blood CD14++CD16+ monocytes (intermediate monocytes; IM) and vascular endothelial growth factors (VEGFs) are associated with formation of collateral circulation. MethodsWe enrolled 49 patients with AMI who underwent emergency percutaneous transluminal coronary intervention (PCI) (Group A) and 27 patients underwent delayed PCI 1 week after AMI (Group B). The percentage of circulating IM and levels of VEGFs in circulation were determined on day 8th. Left ventricular ejection fraction (LVEF) was measured 3 months after AMI. ResultsThe peripheral levels of IM and serum VEGF levels on day 8th were significantly higher in patients with well-developed collateral circulation in Group A than those in Group B. The levels of circulating VEGFs in the collateral circulation (+) subgroup in Group B were lower than those in the collateral circulation (−) subgroup. Moreover, the serum VEGF-B186 levels positively correlated with IM. ConclusionsHyperacute collateral formation in patients with AMI correlated with a higher percentage of CD14++CD16+ monocytes and VEGF-B186 levels in the circulation, which was associated with milder left ventricular remodeling. The regulation of CD14++CD16+ monocytes and VEGF-B may be critical to the formation of collateral circulation and to healing AMI.

Association of Visceral Fat Index with Coronary Collateral Circulation in Patients with Coronary Artery Disease

Abstract: Background: Coronary collateral circulation (CCC) is a network of anastomosing channels, established by heart in response to ischemia of myocardium. Hypertension, diabetes mellitus, and BMI are well established risk factors for development of poor CCC. Good CCC minimizes symptoms of angina, reduce the size of infarcts and prevent adverse cardiac events. The current research study was designed to find out the association of visceral adiposity and development of CCC among patients with coronary artery disease. Materials and Methods: The prospective study, conducted in Civil Hospital Karachi, comprised of 270 patients of coronary artery disease. According to the Rentrop Cohen categorization, patients were placed into two groups: the group with good collateral circulation having Rentrop grades i2-3 (n = 140) and the group with poor collateral circulation having Rentrop grades i0-1(n = 130). Rentrop score was determined by angiography. Segmental multi-frequency bioelectrical impedance analyzer was used to determine body fat mass and body muscle mass. Using Omron body fat and weight measurement systems, visceral fat index (VFI) was evaluated to determine the composition of visceral adipose tissue. SPSS was used for data analysis (Version 22). To assess the independent risk factor for poor CCC, logistic regression analysis was used. ROC curve was constructed to assess the efficacy of VFI in identifying CCC. Results: Overall, good collateral circulations were observed in 51.9% (n=140) of CAD patients, whereas poor collateral circulations were ound in 48.1% (n=130) of patients. Poor CCC was significantly associated with hypertension (OR=3, 95%CI= 0.111-8.231, p = .001) and VFI (OR=2, 95%CI= 1.451-3.567, p =.001). ROC analysis revealed a VFI &gt; 9 to be a potential predictor of poor CCC with AUC=0.9, sensitivity of 95.00% and specificity of 86%. Conclusion: The current study concluded that greater VFI and concomitant hypertension considerably increase the likelihood of having poor CCC, therefore, visceral adiposity can be considered as a potential target for preventing poor collateral circulation in patients with established cardiac disease.

Effect of Early Coronary Collateral Circulation in Patients with ST Elevation Myocardial Infarction

Background and Aims: Coronary collateral circulation can develop early after STEMI and patients having these coronary collaterals have favorable outcomes. The aim of this study was to evaluate the prognostic impact of coronary collateral circulation in STEMI.&#x0D; Methods: This is an observational prospective study of 106 consecutive STEMI patients undergoing Primary PCI admitted and treated at a tertiary cardiac centre from May 2019 to April 2020. Clinical profile, complications at index admission and atone month follow up were analyzed.&#x0D; Results: Out of 106 consecutive patients, 50(47%) had early coronary collateral supplying the infarct related artery. The baseline characteristics of the patients in the two groups, with collateral and without collateral, were similar. Among patients with collateral circulation, only 5% had very well developed (Rentrop3) collaterals. The presence of collateral was strongly associated with presence of preexisting angina (p=0.007) and delayed presentation to hospital (p= 0.04). Coronary collateral was more common in non-diabetics, non-anterior wall STEMI and those with mutivessel disease. Compared with the patients without collateral supply, those who had collateral had fewer incidence of in-hospital heart failure (p=0.03) and post MI pericarditis (p=0.04).&#x0D; Conclusion: In STEMI, development or recruitment of early collateral supply to the infarct related artery was associated with lower rates of heart failure, post MI pericarditis, cardiogenic shock, hospital stay and in-hospital deaths. At 1 month, patients with collateral supply had fewer angina recurrence, reinfarcton and stent thrombosis.

The effect of interarm blood pressure difference on coronary collateral flow in patients with ST-segment elevation myocardial infarction who had undergone primary percutaneous coronary intervention.

In patients with acute myocardial infarction, coronary collateral circulation (CCC) is associated with reduced infarct size, preserved cardiac function, and decreased mortality. An interarm blood pressure difference (IABPD) is shown to be independently associated with cardiovascular and all-cause of mortality. We aimed to determine the effect of IABPD on coronary collateral flow in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (p-PCI). We prospectively investigated 1,348 consecutive patients who were hospitalized for STEMI and underwent p-PCI. The Rentrop classification was used to assess CCC. According to this classification, we defined Rentrop 0 and 1 as poor CCC, and Rentrop 2 and 3 as good CCC. A 10 mm Hg difference is considered the upper limit of IABPD. Patients were divided into two groups according to the collateral circulation, 325 patients (24%) had good collateral, while 1,023 patients (76%) had poor collateral. IABPD was significantly higher in the poor collateral group (57 patients, 5.6%) than in the good collateral group (9 patients, 2.8%) (p=0.04). Pre-infarction angina and IABPD were identified as independent predictors of poor collateral (OR: 0.516, 95% CI 0.370-0.631, p=0.007; OR: 3.681, 95% CI: 1.773-7.461, p=0.01, respectively) in multivariate analysis. The IABPD was shown as an independent predictor of poor collateral circulation in patients with STEMI who underwent p-PC.

Hyperinsulinemia Impaired Coronary Collateral Circulation in Patients with Chronic Total Coronary Occlusion.

Hyperinsulinemia impaired cardiovascular system and endothelial function in the population. The purpose of this study was to explore the relationship between hyperinsulinemia and coronary collateral circulation in patients with chronic total coronary occlusion. Patients with stable angina and at least one total coronary occlusion were enrolled in this study. Collateral grade was determined according to Rentrop's classification. Patients were divided into a good coronary collateral circulation (CCC) group (grade 2 or 3 collateral vessels, n = 223) and a poor CCC group (grade 0 or 1 collateral vessels, n = 115). Fasting insulin level (FINS) and fasting glucose level (FBS) were measured. Endothelial function evaluated by flow-mediated dilation (FMD). Serum FINS level was significantly increased in the poor CCC group (P < 0.01). Patients in the poor CCC group had higher levels of FBS, HbA1C, and homeostasis model assessment for insulin resistance (HOMA-IR) than patients in the good CCC group. The poor CCC group also had lower levels of FMD, lower LVEF and higher syntax scores than the good CCC group. Hyperinsulinemia (T3, FINS ≥15.22 μIU/mL) increased OR for the incidence of the poor CCC group (OR 2.419, 95% CI 1.780-3.287) in multivariate analysis. Multivariate logistic regression also revealed that diabetes, HbA1c, HOMA-IR, HDL-C and Syntax score were independent predictors of poor CCC (all P < 0.05). Hyperinsulinemia is a valuable predictor of poor collateral formation in patients with chronic total coronary occlusion.

Increased Plasma Non-High-Density Lipoprotein Levels and Poor Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease.

This study investigated the relationship between coronary collateral circulation (CCC) and non-high-density lipoprotein cholesterol (non-HDL-C) in patients with stable coronary artery disease (CAD). Coronary collateral circulation plays a critical role in supporting blood flow, particularly in the ischemic myocardium. Previous studies show that non-HDL-C plays a more important role in the formation and progression of atherosclerosis than do standard lipid parameters. A total of 226 patients with stable CAD and stenosis of more than 95% in at least 1 epicardial coronary artery were included in the study. Rentrop classification was used to assign patients into group 1 (n = 85; poor collateral) or 2 (n = 141; good collateral). To adjust for the observed imbalance in baseline covariates between study groups, propensity-score matching was used. Covariates were diabetes, Gensini score, and angiotensin-converting enzyme inhibitor use. In the propensity-matched population, the plasma non-HDL-C level (mean [SD], 177.86 [44.0] mg/dL vs 155.6 [46.21] mg/dL; P = .001) was statistically higher in the poor-collateral group. LDL-C (odds ratio [OR], 1.23; 95% CI, 1.11-1.30; P = .01), non-HDL-C (OR, 1.34; 95% CI, 1.20-1.51; P = .01), C-reactive protein (OR, 1.21; 95% CI, 1.11-1.32; P = .03), systemic immune-inflammation index (OR, 1.14; 95% CI, 1.05-1.21; P = .01), and C-reactive protein to albumin ratio (OR, 1.11; 95% CI, 1.06-1.17; P = .01) remained independent predictors of CCC in multivariate logistic regression analysis. Non-HDL-C was an independent risk factor for developing poor CCC in stable CAD.

Value of Multimodal CT in Predicting and Evaluating Collateral Circulation in Patients with Ischemic Stroke

Value of Multimodal CT in Predicting and Evaluating Collateral Circulation in Patients with Ischemic Stroke

The association of serum uric acid/albumin ratio with the development of coronary collateral circulation in patients with chronic total occluded coronary arteries.

Introduction: Coronary collateral circulation (CCC) develops in chronic total occluded (CTO) vessels and protects the myocardium against ischemia in addition to the improvement of cardiac functions. Poor CCC is related to adverse cardiac events as well as poor prognosis. Serum uric acid/albumin ratio (UAR) has emerged as a novel marker associated with poor cardiovascular outcomes. We aimed to investigate whether there was an association between UAR and poor CCC in CTO patients. Methods: This study was comprised of 212 patients with CTO (92 with poor CCC and 120 with good CCC). All patients were graded based on Rentrop scores to poor CCC (Rentrop scores 0 and 1) and good CCC (Rentrop scores 2 and 3). Results: Poor CCC patients had higher frequencies of diabetes mellitus, triglyceride levels, Syntax and Gensini scores, uric acid, and UAR and lower lymphocyte, high-density lipoprotein cholesterol, and ejection fraction when compared to good CCC patients. UAR was an independent predictor of poor CCC in CTO patients. Furthermore, UAR had a better discriminative ability for patients with poor CCC from good CCC compared to serum uric acid and albumin. Conclusion: Based on the results of the study, the UAR could be used to detect poor CCC in CTO patients.

The relationship between neutrophil-to-lymphocyte ratio and cerebral collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion

BackgroundThe neutrophil/lymphocyte ratio (NLR) has been considered a prognostic indicator for determining the systemic inflammatory response and atherosclerosis. We aimed to determine the relationship between NLR and the development of cerebral collateral circulation in patients with symptomatic severe stenosis or occlusion of intracranial arteries. MethodsAll patients underwent digital subtraction angiography (DSA) within 14 days of admission and were divided into a group with good collateral circulation (77 patients) and a group with poor collateral circulation (86 patients) according to the DSA collateral compensation grading method. Apo B, total cholesterol, LDL, and Neutrophil count in the poor side branch group were significantly higher than in the good side branch group. Multifactorial analysis showed that high NLR levels were a valid predictor of poor collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion. Spearman correlation analysis showed that the size of the collateral branch score was negatively correlated with NLR (r = −0.509, P < 0.001) and cholesterol content (r = −0.249, P = 0.002). NLR predicted poor collateral circulation with an AUC of 0.620 (sensitivity 66.7 %, specificity 61.3 %, 95 % CI = 0.517–0.723,P < 0.05). ConclusionWe demonstrate a correlation between NLR levels and the development of collateral circulation in the brain in patients with symptomatic severe stenosis or occlusion of the intracranial arteries.

Application of transcranial Doppler in cerebrovascular diseases.

Transcranial Doppler (TCD) is a rapid and non-invasive diagnostic technique that can provide real-time measurements of the relative changes in cerebral blood velocity (CBV). Therefore, TCD is a useful tool in the diagnosis and treatment of clinical cerebrovascular diseases (CVDs). In this review, the basic principles of TCD and its application in CVD were outlined. Specifically, TCD could be applied to evaluate occlusive CVD, assess collateral circulation in patients with ischemic stroke, and monitor cerebral vascular occlusion before and after thrombolysis as well as cerebral vasospasm (VSP) and microembolization signals after aneurysmal subarachnoid hemorrhage (SAH). Moreover, TCD could predict short-term stroke and transient cerebral ischemia in patients with anterior circulation occlusion treated with endovascular therapy and in patients with anterior circulation vascular occlusion. Additionally, TCD not only could monitor blood velocity signals during carotid endarterectomy (CEA) or carotid artery stenting (CAS) but also allowed earlier intervention through early recognition of sickle cell disease (SCD). Presently, TCD is a useful prognostic tool to guide the treatment of CVD. On the one hand, TCD is more commonly applied in clinical research, and on the other hand, TCD has an increasing role in the management of patients. Collectively, we review the principles and clinical application of TCD and propose some new research applications for TCD.

Differentially hypomethylated cell-free DNA and coronary collateral circulation

BackgroundThe factors affecting cardioprotective collateral circulation are still incompletely understood. Recently, characteristics, such as CpG methylation of cell-free DNA (cfDNA), have been reported as markers with clinical utility. The aim of this study was to evaluate whether cfDNA methylation patterns are associated with the grade of coronary collateral circulation (CCC).ResultIn this case–control study, clinical and angiographic data were obtained from 143 patients (mean age, 58 years, male 71%) with chronic total coronary occlusion. Enzymatic methyl-sequencing (EM-seq) libraries were prepared using the cfDNA extracted from the plasma. Data were processed to obtain the average methylation fraction (AMF) tables of genomic regions from which blacklisted regions were removed. Unsupervised analysis of the obtained AMF values showed that some of the changes in methylation were due to CCC. Through random forest preparation process, 256 differentially methylated region (DMR) candidates showing strong association with CCC were selected. A random forest classifier was then constructed, and the area under the curve of the receiver operating characteristic curve indicated an appropriate predictive function for CCC. Finally, 20 DMRs were identified to have significantly different AMF values between the good and poor CCC groups. Particularly, the good CCC group exhibited hypomethylated DMRs. Pathway analysis revealed five pathways, including TGF-beta signaling, to be associated with good CCC.ConclusionThese data have demonstrated that differential hypomethylation was identified in dozens of cfDNA regions in patients with good CCC. Our results support the clinical utility of noninvasively obtained epigenetic signatures for predicting collateral circulation in patients with vascular diseases.

The relationship between mean platelet volume lymphocyte ratio and collateral circulation in patients with chronic total coronary occlusion.

To correlate mean platelet volume lymphocyte ratio (MPVLR) and coronary collateral circulation (CCC) in patients with chronic total occlusion (CTO). A total of 643 patients who were hospitalized at a single large academic medical center from January 2020 to October 2021 and had CTO lesions in at least one major coronary artery confirmed by coronary angiography were retrospectively analyzed. Patients were divided according to the Rentrop criteria into poorly formed CCC (Rentrop grade 0-1, n = 235) and well-formed CCC (Rentrop grade 2-3, n = 408) groups. Mean platelet volume lymphocyte ratio (MPVLR) was calculated from routine laboratory data (MPV divided by lymphocyte count). The clinical data of the two groups were compared, and relationships between MPVLR and CCC formation were analyzed. The MPVLR of patients with poorly formed CCC was significantly higher than that of patients with well-formed CCC (7.82 ± 3.80 vs. 4.84 ± 1.42, P < 0.01). The prevalence of diabetes mellitus and C-reactive protein levels were significantly higher in the poor CCC group than in the good CCC group (P < 0.01), while the proportions of patients with CTO or multivessel lesions in the right coronary artery were significantly lower in the poor CCC group than in the good CCC group (P < 0.01). Multivariate logistic regression analysis identified MPVLR (OR: 2.101, 95% CI: 1.840-2.399, P < 0.01), C-reactive protein level (OR: 1.036, 95% CI: 1.008-1.064, P < 0.05), a history of diabetes mellitus (OR: 2.355, 95% CI: 1.532-3.621, P < 0.01), and right coronary CTO ratio (OR: 0.313, 95% CI: 0.202-0.485, P < 0.01) as independent risk factors for CCC formation. The area under the ROC curve of MPVLR for predicting poorly formed CCC was 0.82 (95% CI: 0.784-0.855, P < 0.01), the best cut-off point was 6.02 and the sensitivity and specificity of MPVLR for predicting poorly formed CCC were 72.3 and 82.4%, respectively. In patients with coronary CTO, MPVLR was negatively correlated with CCC and a high MPVLR level was an independent predictor of poorly formed CCC.