Related Experiment Videos
Collateral circulation in coronary artery disease
Insights
Coronary collateral circulation is only visible with total or near-total artery blockage. Good or poor collateral flow does not impact left ventricular wall motion abnormalities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Collateral circulation plays a crucial role in myocardial perfusion during coronary artery occlusion.
- Understanding the angiographic visualization and functional impact of collateral circulation is vital for patient management.
Purpose of the Study:
- To determine the threshold of coronary artery stenosis for angiographic visualization of collateral circulation.
- To analyze the relationship between the quality of collateral circulation and left ventricular (LV) segmental wall motion in patients with significant coronary artery disease.
Main Methods:
- Retrospective review of coronary arteriograms and left ventriculograms in 202 patients with at least 75% diameter reduction in major coronary arteries.
- Quantification of coronary artery stenosis and assessment of collateral circulation using established grading systems.
- Evaluation of LV segmental wall motion (normal, hypokinetic, akinetic/dyskinetic) in relation to collateral flow status.
Main Results:
- Collateral circulation was observed in 63% of patients with at least one totally occluded major coronary artery.
- Angiographically demonstrable collateral circulation was only present in cases of total (100%) or near-total (99%) coronary artery occlusion.
- No significant difference in LV wall motion abnormalities was found between arteries with good versus poor collateral circulation.
- LV function did not consistently correlate with the presence or absence of collateral flow.
Conclusions:
- Angiographic visualization of coronary collateral circulation requires total or near-total coronary artery occlusion.
- The presence and quality of collateral circulation, as visualized angiographically, do not significantly correlate with the degree of left ventricular wall motion abnormalities.
- These findings suggest that collateral circulation's functional significance in preserving LV function may be more complex than previously assumed based solely on angiographic assessment.
Abstract:
The coronary arteriograms and left ventriculograms of 202 consecutive patients were reviewed. All had at least 75% diameter reduction of 1 or more major coronary arteries. In 127 patients (63%), at least 1 major branch was totally occluded. Collateral circulation was seen in 125 of these 127 patients (190 of 192 totally occluded arteries). Of the 75 patients without total occlusion, only 2 with 99% (or near-total) occlusion had demonstrable collateral circulation (2 of 208 arteries). In no patient with 75 to 98% diameter narrowing was collateral circulation demonstrated (0 of 164 arteries). An analysis was made of the relation between left ventricular (LV) segmental wall motion and the quality of collateral circulation in 190 totally occluded arteries among 125 patients. Of 126 arteries with good collateral circulation, LV contraction was normal in 21%, hypokinetic in 48% and akinetic/dyskinetic in 29%. Of 64 arteries with poor collateral circulation, LV contraction was normal in 23%, hypokinetic in 55% and akinetic/dyskinetic in 20%. There was no statistically significant difference between the effect of good or poor collateral circulation on LV function. These data indicate that collateral circulation cannot be seen angiographically unless there is total or near-total occlusion, and that the presence of collateral circulation does not correlate with LV wall motion abnormalities, i.e., akinetic area, despite good collateral flow or normal wall motion despite absent or poor collateral flow.