Exploring collateral influences in multivessel coronary artery disease
Research type
Research Study
Full title
Experimental manipulation of indices of lesion severity in coronary artery disease : Quantitative exploration of collateral influences.
IRAS ID
153440
Contact name
Justin Davies
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
In coronary artery disease (CAD), fatty deposits can build up in blood vessels on the surface of the heart causing narrowings (stenoses) and symptoms like chest pain or shortness of breath.
Doctors can treat these narrowings with stenting (using a balloon to physically open the vessel up), but this can be risky and expensive and should only be done for narrowings that are ‘significant’ (severe enough to starve the heart of oxygen). If narrowings are ‘non-significant’, tablet therapy is preferred. Fractional Flow Reserve (FFR) is a technique that gives a numerical value of stenosis severity, informing doctors when a narrowing is significant or non-significant.
However, when there are narrowings in multiple vessels (so called multi-vessel CAD), FFR values can be difficult to interpret.
E.g: If stenoses in two vessels (Vessel A and Vessel B) are significant by FFR, after the first vessel is stented, there are two possibilities.
• Scenario 1: After stenting Vessel A, the stenosis in Vessel B becomes ‘non-significant’. What initially appeared to be significant disease of two vessels has been treated with only a single vessel being stented. So called ‘2-4-1 stenting’.
• Scenario 2: After stenting Vessel A, the stenosis in Vessel B remains significant and two vessel stenting is still required.In clinical practice it is difficult to predict which of these scenarios will occur. Therefore, we may routinely be exposing patients to unnecessary coronary stenting (and excess risk). Despite its importance, data on this effect is very limited and the mechanisms involved remain unknown.
This study, through a series of simple experiments in patients with multi-vessel disease, aims to define the mechanisms behind the ‘2-4-1 stenting’ effect. Our findings could help improve the safety and cost effectiveness of the management of CAD in this important patient group.
REC name
London - Bloomsbury Research Ethics Committee
REC reference
15/LO/1644
Date of REC Opinion
21 Oct 2015
REC opinion
Further Information Favourable Opinion