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Coronary Collateral Circulation

  • Novalia Purnama Sidik
  • James Spratt
  • Margaret McEntegart
Chapter

Abstract

Coronary collateral circulation is the small vessel connections formed between one epicardial coronary artery and another. The existence of these coronary anastomoses was demonstrated by Fulton in 1963. Rentrop and Werner subsequently devised collateral classification systems using angiographic characteristics as surrogates for collateral function. While these classifications are widely used in the clinical setting, the gold standard assessment of collateral function is the invasively measured collateral flow index. Several clinical and angiographic variables correlate with the degree of collateralization, and well-developed collateral circulation has the potential to both preserve myocardial function and improve survival. This protective function is commonly seen in the presence of chronic total occlusions (CTOs), while with an acute coronary occlusion the collateral circulation is usually inadequate to prevent myocardial ischemia and injury. Beyond this protective role, in CTO percutaneous coronary intervention (PCI) the collaterals allow visualization of the distal coronary bed beyond the occlusive segment and provide retrograde access to the occluded vessel to facilitate recanalization. The specific collateral pathways available and the characteristics of the collateral anatomy have implications for the feasibility and safety of obtaining retrograde access to the target vessel. Performing an assessment of the collateral pathways and their anatomical characteristics during procedural planning can improve CTO PCI procedural efficiency and success.

References

  1. 1.
    Fulton WF. Arterial anastomoses in the coronary circulation. I. Anatomical features in normal and diseased hearts demonstrated by stereoarteriography. Scott Med J. 1963;8:420–34.CrossRefPubMedGoogle Scholar
  2. 2.
    Seiler C. The human coronary collateral circulation. Eur J Clin Investig. 2010;40:465–76.CrossRefGoogle Scholar
  3. 3.
    Wustmann K, Zbinden S, Windecker S, Meier B, Seiler C. Is there functional collateral flow during vascular occlusion in angiographically normal coronary arteries? Circulation. 2003;107:2213–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Elsman P, van’t Hof AW, de Boer MJ, et al. Role of collateral circulation in the acute phase of ST-segment-elevation myocardial infarction treated with primary coronary intervention. Eur Heart J. 2004;25:854–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Fukai M, Ii M, Nakakoji T, et al. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction: a regional metabolic study. J Cardiol. 2000;35:103–11.PubMedGoogle Scholar
  6. 6.
    Habib GB, Heibig J, Forman SA, et al. Influence of coronary collateral vessels on myocardial infarct size in humans. Results of phase I Thrombolysis in Myocardial Infarction (TIMI) trial. The TIMI Investigators. Circulation. 1991;83:739–46.CrossRefPubMedGoogle Scholar
  7. 7.
    Hansen JF. Coronary collateral circulation: clinical significance and influence on survival in patients with coronary artery occlusion. Am Heart J. 1989;117:290–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Meier P, Gloekler S, Zbinden R, et al. Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation. 2007;116:975–83.CrossRefPubMedGoogle Scholar
  9. 9.
    Meier P, Hemingway H, Lansky AJ, Knapp G, Pitt B, Seiler C. The impact of the coronary collateral circulation on mortality: a meta-analysis. Eur Heart J. 2012;33:614–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Perez-Castellano N, Garcia EJ, Abeytua M, et al. Influence of collateral circulation on in-hospital death from anterior acute myocardial infarction. J Am Coll Cardiol. 1998;31:512–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Seiler C, Meier P. Historical aspects and relevance of the human coronary collateral circulation. Curr Cardiol Rev. 2014;10:2–16.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Levin DC. Pathways and functional significance of the coronary collateral circulation. Circulation. 1974;50:831–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985;5:587–92.CrossRefPubMedGoogle Scholar
  14. 14.
    Arras M, Ito WD, Scholz D, Winkler B, Schaper J, Schaper W. Monocyte activation in angiogenesis and collateral growth in the rabbit hindlimb. J Clin Invest. 1998;101:40–50.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ito WD, Arras M, Winkler B, Scholz D, Schaper J, Schaper W. Monocyte chemotactic protein-1 increases collateral and peripheral conductance after femoral artery occlusion. Circ Res. 1997;80:829–37.CrossRefPubMedGoogle Scholar
  16. 16.
    Sasayama S, Fujita M. Recent insights into coronary collateral circulation. Circulation. 1992;85:1197–204.CrossRefPubMedGoogle Scholar
  17. 17.
    Buschmann I, Schaper W. The pathophysiology of the collateral circulation (arteriogenesis). J Pathol. 2000;190:338–42.CrossRefPubMedGoogle Scholar
  18. 18.
    van Royen N, Piek JJ, Buschmann I, Hoefer I, Voskuil M, Schaper W. Stimulation of arteriogenesis; a new concept for the treatment of arterial occlusive disease. Cardiovasc Res. 2001;49:543–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Fujita M, Sasayama S, Ejiri M, Asanoi H, Nakajima H, Miwa K. Coronary collateral development after acute myocardial infarction. Clin Cardiol. 1988;11:525–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Rentrop KP, Feit F, Sherman W, Thornton JC. Serial angiographic assessment of coronary artery obstruction and collateral flow in acute myocardial infarction. Report from the second Mount Sinai–New York University Reperfusion Trial. Circulation. 1989;80:1166–75.CrossRefPubMedGoogle Scholar
  21. 21.
    Schwartz H, Leiboff RH, Bren GB, et al. Temporal evolution of the human coronary collateral circulation after myocardial infarction. J Am Coll Cardiol. 1984;4:1088–93.CrossRefPubMedGoogle Scholar
  22. 22.
    van den Akker J, Schoorl MJ, Bakker EN, Vanbavel E. Small artery remodeling: current concepts and questions. J Vasc Res. 2010;47:183–202.CrossRefPubMedGoogle Scholar
  23. 23.
    de Marchi SF, Gloekler S, Meier P, et al. Determinants of preformed collateral vessels in the human heart without coronary artery disease. Cardiology. 2011;118:198–206.CrossRefPubMedGoogle Scholar
  24. 24.
    Helfant RH, Kemp HG, Gorlin R. Coronary atherosclerosis, coronary collaterals, and their relation to cardiac function. Ann Intern Med. 1970;73:189–93.CrossRefPubMedGoogle Scholar
  25. 25.
    Piek JJ, van Liebergen RA, Koch KT, Peters RJ, David GK. Clinical, angiographic and hemodynamic predictors of recruitable collateral flow assessed during balloon angioplasty coronary occlusion. J Am Coll Cardiol. 1997;29:275–82.CrossRefPubMedGoogle Scholar
  26. 26.
    Pohl T, Seiler C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development. Functional collateral channel measurement in 450 patients with coronary artery disease. J Am Coll Cardiol. 2001;38:1872–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Werner GS, Ferrari M, Betge S, Gastmann O, Richartz BM, Figulla HR. Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of occlusion. Circulation. 2001;104:2784–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Werner GS, Ferrari M, Heinke S, et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation. 2003;107:1972–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Pijls NH, van Son JA, Kirkeeide RL, De Bruyne B, Gould KL. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993;87:1354–67.CrossRefPubMedGoogle Scholar
  30. 30.
    Seiler C, Fleisch M, Garachemani A, Meier B. Coronary collateral quantitation in patients with coronary artery disease using intravascular flow velocity or pressure measurements. J Am Coll Cardiol. 1998;32:1272–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Seiler C. Collateral circulation of the heart. London: Springer; 2009.CrossRefGoogle Scholar
  32. 32.
    Koerselman J, de Jaegere PP, Verhaar MC, Grobbee DE, van der Graaf Y, Group SS. Prognostic significance of coronary collaterals in patients with coronary heart disease having percutaneous transluminal coronary angioplasty. Am J Cardiol. 2005;96:390–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Seiler C. The human coronary collateral circulation. Heart. 2003;89:1352–7.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bache RJ, Schwartz JS. Myocardial blood flow during exercise after gradual coronary occlusion in the dog. Am J Phys. 1983;245:H131–8.Google Scholar
  35. 35.
    Antoniucci D, Valenti R, Moschi G, et al. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol. 2002;89:121–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Werner GS, Emig U, Mutschke O, Schwarz G, Bahrmann P, Figulla HR. Regression of collateral function after recanalization of chronic total coronary occlusions: a serial assessment by intracoronary pressure and Doppler recordings. Circulation. 2003;108:2877–82.CrossRefPubMedGoogle Scholar
  37. 37.
    Cohen M, Rentrop KP. Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation. 1986;74:469–76.CrossRefPubMedGoogle Scholar
  38. 38.
    Kodama K, Kusuoka H, Sakai A, et al. Collateral channels that develop after an acute myocardial infarction prevent subsequent left ventricular dilation. J Am Coll Cardiol. 1996;27:1133–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Di Carli M, Sherman T, Khanna S, et al. Myocardial viability in asynergic regions subtended by occluded coronary arteries: relation to the status of collateral flow in patients with chronic coronary artery disease. J Am Coll Cardiol. 1994;23:860–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Elhendy A, Cornel JH, Roelandt JR, et al. Impact of severity of coronary artery stenosis and the collateral circulation on the functional outcome of dyssynergic myocardium after revascularization in patients with healed myocardial infarction and chronic left ventricular dysfunction. Am J Cardiol. 1997;79:883–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Seiler C, Engler R, Berner L, et al. Prognostic relevance of coronary collateral function: confounded or causal relationship? Heart. 2013;99:1408–14.CrossRefPubMedGoogle Scholar
  42. 42.
    McEntegart MB, Badar AA, Ahmad FA, et al. The collateral circulation of coronary chronic total occlusions. EuroIntervention. 2016;11:e1596–603.CrossRefPubMedGoogle Scholar
  43. 43.
    Hoefer IE, van Royen N, Buschmann IR, Piek JJ, Schaper W. Time course of arteriogenesis following femoral artery occlusion in the rabbit. Cardiovasc Res. 2001;49:609–17.CrossRefPubMedGoogle Scholar
  44. 44.
    Lovell MJ, Mathur A. Cardiac stem cell therapy: progress from the bench to bedside. Heart. 2010;96:1531–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Meier P, Seiler C. The coronary collateral circulation—clinical relevances and therapeutic options. Heart. 2013;99:897–8.CrossRefGoogle Scholar
  46. 46.
    Fulton WFM. Immersion radiography of injected specimens. Br J Radiol. 1963;36:687.CrossRefGoogle Scholar
  47. 47.
    Okamura A, Yamane M, Muto M, et al. Complications during retrograde approach for chronic coronary total occlusion: Subanalysis of Japanese multicenter registry. Cathet Cardiovasc Intervent. 2016;88:7–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Novalia Purnama Sidik
    • 1
  • James Spratt
    • 2
  • Margaret McEntegart
    • 1
  1. 1.Golden Jubilee National Hospital, CardiologyGlasgowUK
  2. 2.St George’s Hospital, CardiologyLondonUK

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