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.

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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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