Physiologic significance of coronary collaterals in chronic total occlusions.
Chronic total occlusions (CTOs) are commonly found in patients with coronary artery disease, and a system of collateral connections are found in almost all of these patients. These collateral vessels serve to prevent myocardial necrosis but are not sufficient to prevent myocardial ischemia during exercise. Unfortunately, the presence of well-developed collaterals has been used as argument against CTO revascularization. Many continue to falsely believe that these patients are "protected" by collaterals and, therefore, CTO recanalization is not indicated. Our knowledge of the physiologic significance of coronary collaterals has increased significantly over the past several years. Studies utilizing coronary pressure and flow velocity have answered a number of basic physiologic questions. We therefore sought to review the evidence for coronary collateral flow and their clinical significance in patients with CTOs.
a University of Manitoba, Section of Cardiology, St. Boniface Hospital, 409 Tache Ave., Winnipeg, MB R2H 2A6, Canada.
Minh N
MN
Vo
b Veterans Affairs North Texas Healthcare System; University of Texas Southwestern Medical Center, Dallas, TX, USA.
Emmanouil S
ES
Brilakis
a University of Manitoba, Section of Cardiology, St. Boniface Hospital, 409 Tache Ave., Winnipeg, MB R2H 2A6, Canada.
Malek
M
Kass
a University of Manitoba, Section of Cardiology, St. Boniface Hospital, 409 Tache Ave., Winnipeg, MB R2H 2A6, Canada.
Amir
A
Ravandi
D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D016277:Ventricular Function, Left / Q000502:physiology*
angioplastie; angioplasty; chronic total occlusions; coronaropathie; coronary artery disease; interventions coronariennes percutanées; occlusions totales chroniques; percutaneous coronary interventions