To the Editor:
I enjoyed the excellent review article on “coronary collaterals” by Koerselman et al.1 It helps explain one of the mechanisms by which positive remodeling of a coronary artery is associated with a poorer prognosis than is negative remodeling. In positive remodeling, the outwardly directed plaque growth leads to expansion of vessel size rather than changes in lumen size.2 This is in contrast to negative remodeling in which plaque growth is associated with progressive luminal narrowing.3 The lack of correlation between plaque growth and luminal narrowing during positive remodeling allows for the development of a larger plaque burden before development of any signs or symptoms of ischemia when compared with negative remodeling.3 In the absence of recurrent ischemia, there will be less stimulation for the formation of collateral vessels. This would render the patient with positive remodeling more vulnerable to the adverse affects of an ischemic episode during plaque rupture and thrombosis than the patient with negative remodeling would be.
Koerselman J, Van der Graaf Y, de Jaegere PPT, et al. Coronary collaterals: an important and underexposed aspect of coronary artery disease. Circulation. 2003; 107: 2507–2511.
Schoenhagen P, Nissen SE, Tuzcu EM. Arterial remodeling and coronary plaque vulnerability: insights from intravascular ultrasound. Cardiovasc Rev Rep. 2001; 22: 102–106.