Circulation. 2003;107:2507-2511
doi: 10.1161/01.CIR.0000065118.99409.5F
doi: 10.1161/01.CIR.0000065118.99409.5F
(Circulation. 2003;107:2507.)
© 2003 American Heart Association, Inc.
Special Review |
Coronary Collaterals
An Important and Underexposed Aspect of Coronary Artery Disease
From the Julius Center for Health Sciences and Primary Care (www.juliuscenter.nl) (J.K., Y.v.d.G., D.E.G.) and Department of Cardiology, Heart Lung Center Utrecht (P.P.Th.d.J.), University Medical Center Utrecht, the Netherlands.
Correspondence to Diederick E. Grobbee, MD, PhD, Professor of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht), HP D 01.335, Heidelberglaan 100, P.O. Box 85.500, 3508 GA Utrecht, The Netherlands. E-mail: D.E.Grobbee@jc.azu.nl
Key Words: angiogenesis • collateral circulation • coronary disease • growth substances • prevention
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Important risk factors for cardiovascular disease (CVD) have been identified, but they fail to explain why some patients with atherosclerosis become symptomatic and have recurrent symptomatic disease, and others do not. Apart from the extent of coronary atherosclerosis (among other factors), the sensitivity of organs to episodes of ischemia is probably of importance. An organ may be less sensitive to episodes of ischemia if supplied with sufficient blood flow by well-developed collateral vessels. Unfortunately, some organs or even some individuals do not appear to have well-developed collateral vessels, if developed at all. At present, it is not clear why there are differences between individuals in their capability of developing a sufficient collateral circulation. The potential of individuals to develop coronary collateral circulation has so far been largely neglected but may play a major role in determining myocardial vulnerability.
In the present article, we propose why coronary collaterals are important, and why this individual potential to develop collaterals should be considered an additional indicator of cardiac vulnerability. Also, we review determinants that play a role in collateral coronary blood supply.
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Coronary Collateral Circulation: Current Knowledge |
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Coronary collaterals, or "natural bypasses," are anastomotic connections without an intervening capillary bed between portions of the same coronary artery and between different coronary arteries (Figure 1).1 Collateral circulation potentially offers an important alternative source of blood supply when the original vessel fails to provide sufficient blood.2 Timely enlargement of collaterals may even avoid transmural myocardial infarction (MI) and death in symptomatic patients.3 As early as in 1956, Baroldi
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