title: The sword of Damocles: an illustrative example of the life-saving effect of the collateral circulation.
abstract: There is an ongoing debate on the effective importance of the collateral network, especially in the current era, where most patients with significant coronary artery disease are revascularized, be it percutaneously or surgically; thus, people may question a significant benefit of the coronary collateral circulation. However, the presented 61-year-old male patient demonstrates an unambiguous situation of a life-saving effect of the collateral circulation. The patient presented without any angina symptoms and with only mild shortness of breath on moderate to severe exertion. A subsequent angiography revealed a complete chronic occlusion of the main coronary artery. The entire left coronary system was provided by well-developed right to left collaterals. Additionally, the patient had an 80-90% stenosis of his mid-right coronary artery (RCA). The entire blood supply to the heart had to pass this lesion to provide the RCA area and also the left anterior descending and left circumflex areas via collaterals. This extreme example illustrates the potentially lifesaving effect of the coronary collateral circulation. Obviously, the entire myocardium can in some cases be perfused entirely via one critically stenosed vessel.
authors.affiliation: University College London Hospital, 16-18 Westmoreland Street, London, United Kingdom. pascal.meier@uclh.nhs.uk
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
mesh_terms: D001157:Arterial Occlusive Diseases / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D004417:Dyspnea / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome