Relations between collateral flow and tissue salvage in the risk area after acute coronary occlusion in dogs: a...

Localization of salvaged tissue after occlusion of the left anterior descending coronary artery due to collateral blood flow within the risk area was examined in a canine model using differential autoradiography. 125I tracer microspheres were injected into the left anterior descending artery preocclusively to define the perfusion territory as a risk area. 99mTc labelled human serum albumin microspheres were injected into both the left main and right coronary arteries 48 h after ligation to determine the collateral flow area. Using a cryotome, 50 micron transverse sections of the whole heart were taken, and 125I and 99mTc autoradiograms were obtained independently. The same specimens were stained by the nitroblue-tetrazolium method to demarcate the intact and infarcted myocardium. The tracings of the infarct, risk and collateral areas were compared and measured by a plainmeter. The collateral blood flow was distributed to 86, 55 and 42% of the epi, mid- and endo-cardial portions of the risk area respectively (P less than 0.001 between the epi- and mid- or endo-cardium). Within the collateral area 88, 58 and 63% of the epi-, mid- and endo-cardial portions were free of myocardial necrosis (P less than 0.001 between the epi- and mid- or endo-cardium). There was a close linear relationship between the size of salvaged and collateral areas (r = 0.96, P less than 0.001). Thus, a topographical analysis of the tissue salvage inside the risk area demonstrated the indispensable role of collateral blood flow for maintaining tissue viability.