The Human Coronary Collateral Circulation, Its Extracardiac Anastomoses and Their Therapeutic Promotion
Marius Reto Bigler1, Christian Seiler2
1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Insights
New strategies are needed for coronary artery disease (CAD) patients with limited options. Promoting coronary collateral circulation, an important network for preventing myocardial ischemia, offers a promising therapeutic approach.
Area of Science:
- Cardiovascular Research
- Medical Science
Background:
- Cardiovascular disease is the leading cause of global mortality.
- Coronary artery disease (CAD) presents a growing challenge with limited treatment options.
- Existing therapies like PCI, CABG, and medical management are insufficient for some patients.
Purpose of the Study:
- To review the principles of human coronary collateral circulation.
- To explore extracardiac anastomoses and their role in CAD.
- To evaluate therapeutic strategies for promoting collateral circulation, including internal mammary artery occlusion.
Main Methods:
- Literature review of coronary collateral circulation.
- Analysis of extracardiac anastomoses.
- Synthesis of therapeutic approaches for collateral circulation enhancement.
Main Results:
- Coronary collateral circulation is a key factor in mitigating myocardial ischemia.
- Extracardiac anastomoses provide alternative pathways for blood flow.
- Stimulating collateral circulation, e.g., via internal mammary artery occlusion, is a potential therapeutic avenue.
Conclusions:
- Coronary collateral circulation is a vital protective mechanism in CAD.
- Enhancing collateral flow presents a promising alternative treatment strategy.
- Further research into methods like internal mammary artery occlusion is warranted for CAD management.
Abstract:
Cardiovascular disease remains the leading global cause of death, and the number of patients with coronary artery disease (CAD) and exhausted therapeutic options (i.e., percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical treatment) is on the rise. Therefore, the evaluation of new therapeutic approaches to offer an alternative treatment strategy for these patients is necessary. A promising research field is the promotion of the coronary collateral circulation, an arterio-arterial network able to prevent or reduce myocardial ischemia in CAD. This review summarizes the basic principles of the human coronary collateral circulation, its extracardiac anastomoses as well as the different therapeutic approaches, especially that of stimulating the extracardiac collateral circulation via permanent occlusion of the internal mammary arteries.
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