The collateral circulation of the heart
Pascal Meier1, Stephan H Schirmer, Alexandra J Lansky
1The Heart Hospital London, University College London Hospitals UCLH, London, UK. pascalmeier74@gmail.com
Insights
Coronary collateral arteries offer protective benefits in coronary artery disease by providing alternative blood flow. Therapeutic strategies to enhance these vessels show promising results in recent pilot studies.
Area of Science:
- Cardiovascular Science
- Medical Research
Background:
- Coronary arteries were historically viewed as end arteries.
- Anastomotic vessels, or collateral arteries, interconnect epicardial coronary arteries.
- These collaterals supply the myocardium during occlusive coronary artery disease.
Purpose of the Study:
- To investigate the role and therapeutic potential of coronary collateral arteries.
- To summarize current understanding of collateral circulation assessment and enhancement.
Main Methods:
- Review of existing literature on coronary collateral circulation.
- Discussion of assessment methods, including intracoronary pressure measurements.
- Analysis of therapeutic strategies, including past clinical trials and recent pilot studies.
Main Results:
- Increasing evidence supports a protective role for collateral arteries in coronary artery disease.
- Intracoronary pressure measurements are the gold standard for assessing collateral function.
- Initial therapeutic trials were unsuccessful, but recent pilot studies show promise.
Conclusions:
- Coronary collateral arteries play a significant protective role in coronary artery disease.
- Therapeutic induction of collateral growth remains an area of active research.
- Emerging strategies like external counterpulsation and G-CSF show potential for enhancing collateral circulation.
Abstract:
The coronary arteries have been regarded as end arteries for decades. However, there are functionally relevant anastomotic vessels, known as collateral arteries, which interconnect epicardial coronary arteries. These vessels provide an alternative source of blood supply to the myocardium in cases of occlusive coronary artery disease. The relevance of these collateral arteries is a matter of ongoing debate, but increasing evidence indicates a relevant protective role in patients with coronary artery disease. The collateral circulation can be assessed by different methods; the gold standard involves intracoronary pressure measurements. While the first clinical trials to therapeutically induce growth of collateral arteries have been unavailing, recent pilot studies using external counterpulsation or growth factors such as granulocyte colony stimulating factor (G-CSF) have shown promising results.
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