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Results for “Collateral Circulation”

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PubMed1991

[Correlations between redistribution areas observed on exercise thallium-201 myocardial SPECT images and the coronary collateral circulations in patients with myocardial infarction].

The significance of coronary collateral circulation for redistribution in the infarcted zone was evaluated in 16 patients with history of myocardial infarction and severe stenosis (> or = 90%) of the coronary artery. Redistribution areas were quantitatively measured using the redistribution ratios and redistribution indices on the infarction-redistribution map obtained by thallium-201 scintigraphy with single photon emission computed tomography. Coronary collateral findings were categorized in 4 classes according to the Rentrop's grading. There was good, positive linear correlation between the redistribution ratio (Y) and collateral grading (X) (Y = 0.21X + 0.10, r = 0.92, p < 0.01). The redistribution index (X) also correlated well with the collateral grading (Y) using a good, positive quadratic equation (Y = 0.32X2 + 0.24X + 0.04, r = 0.89, p < 0.01). These results suggest that the measurements of the redistribution areas in the ischemic zone in myocardial infarction correlated well with collateral perfusion. Collateral perfusion severer than Rentrop's grade 2 markedly reduces the severity of ischemia and increases redistribution areas.

Collateral Circulation↗

PubMed1990

[Walk-through phenomenon by gradual recruitment of collateral circulation].

The present study was performed to investigate whether coronary collateral vessels open immediately after occurrence of myocardial ischemia. Multistage bicycle exercise was performed to determine the maximum tolerable workload until the onset of angina and significant ST segment depression in 10 patients with well-developed collateral circulation. On a different day, exercise using the maximum tolerable workload was repeated for comparable exercise durations. In two of the 10 patients, anginal pain was gradually alleviated despite the continuation of exercise using the fixed workloads. The extent of ST segment depression during three min exercise with the fixed workload was 0.20 +/- 0.10 (SD) mV, which was significantly (p less than 0.05) greater than 0.16 +/- 0.08 mV at the end of exercise with fixed workload. By contrast, the pressure-rate product was smaller at three min than at the end of exercise using the fixed workload (20,900 +/- 5,500 vs 22,700 +/- 5,700 mmHg-beats/min; p less than 0.05). It was concluded that delayed collateral openings play a critical role in the pathogenesis of the walk-through phenomenon.

Adult↗

PubMed1976

Reappraisal of the functional significance of the coronary collateral circulation.

A review of data in 465 patients with complete obstruction of either the left anterior descending or right coronary artery was undertaken to evaluate the functional role of the collateral circulation. Complete obstruction of a dominant right coronary artery was observed in 288 patients, 83 percent with distal filling and visualization of the posterior descending artery by way of collateral vessels. Complete obstruction of the left anterior descending artery was noted in 177 patients, 71 percent with filling and visualization distal to the obstruction by way of collateral vessels. Among patients with obstruction of the left anterior descending artery, there was a significantly greater frequency of congestive heart failure and cardiomegaly in those without collateral vessels than in those with collateral vessels. The former also had a significantly greater frequency of both electrocardiographic evidence of an anterior wall myocardial infarction and angiographic findings of anterior wall asynergy. The frequency of inferior myocardial infarction and inferior wall asynergy was not influenced by the presence of collateral vessels. These observations indicate that the collateral circulation plays a significant protective role in the presence of obstruction of the left anterior descending artery, which is not apparent with obstruction of the right coronary artery.

Adult↗

PubMed1989

[Changes in platelet aggregation and coronary collateral circulation during the early phase of myocardial ischemia in dogs].

Experiments were performed on 18 anesthetized open-chest dogs to observe the changes in platelet aggregation and coronary collateral circulation during the early phase of acute myocardial ischemia. An increase in platelet aggregation rates (PAgR) and a decrease in platelet counts (PC) were found in the blood collected from the ischemic myocardium after coronary occlusion. PAgR was increased by 58.7 +/- 5.6% and PC was reduced by 39.5 +/- 23.6% at 50 min after occlusion (P less than 0.01). Under the condition of controlling aortic blood pressure, collateral coronary vascular capacity (CVC) was not changed (P greater than 0.05), but the effective collateral coronary flow to the ischemic zone, calculated by Wyatt et al's equation, was significantly reduced by 23.5 +/- 9.7% at 50 min after occlusion (P less than 0.05). There was a negative correlation between the changes in PAgR and the effective collateral coronary flow ( r = -0.857, P less than 0.01), and between the collateral indices and infarct size (r = -0.847, P less than 0.01). Abnormal changes in parameters of platelet and coronary collateral circulation after myocardial ischemia were nearly abolished by intravenous injection of aspirin before coronary occlusion. The results suggest that the deleterious changes of platelet aggregation during the early phase of the acute myocardial ischemia may decrease the effective collateral coronary flow significantly and thereby enlarge the infarct size.

Animals↗

PubMed1985

Superior portosystemic collateral circulation estimated by azygos blood flow in patients with cirrhosis. Lack of correlation with oesophageal varices and gastrointestinal bleeding. Effect of propranolol.

In patients with cirrhosis, superior portosystemic collateral circulation was evaluated by the continuous thermodilution method in the azygos vein. Azygos blood flow was 5 times higher in a group of patients with cirrhosis (alcoholic in 27, cryptogenic in 8, post-hepatitic in 2 and primary biliary cirrhosis in 1), than in a group of patients without portal hypertension (steatosis in 2, granulomatous hepatitis in 2, persistent chronic hepatitis in 2 and Hodgkin's disease in 1). Azygos blood flow was not different in cirrhotic patients with no visible, in those with small-sized, and in those with large sized oesophageal varices. Azygos blood flow was not different in cirrhotic patients with and without a previous episode of gastrointestinal bleeding. Fifteen min after intravenous administration of 15 mg of propranolol, azygos blood flow significantly decreased whereas azygos blood flow did not change after placebo. The decrease in azygos blood flow was significantly more marked than the reduction in cardiac output. It is concluded that superior portosystemic collateral blood flow is elevated in patients with cirrhosis and that the reduction in this collateral circulation might explain the efficiency of propranolol in the prevention of recurrent gastrointestinal bleeding.

Azygos Vein↗

PubMed2004

Poor coronary collateral circulation is associated with higher concentrations of soluble adhesion molecules in patients with single-vessel disease.

OBJECTIVE: As the endothelium and inflammatory cells play a crucial role in the development of collaterals after a sudden or slowly progressing stenosis of coronary arteries, the levels of soluble endothelial adhesion molecules (CAMs) including vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1) and E-selectin were compared between patients with poor coronary collaterals and patients with well-developed collaterals. METHODS: In the study, 97 non-diabetic subjects with single-vessel disease were included. Collateral supply to the stenotic coronary artery was determined by angiographic grading system of 0-3 (Rentrop et al. J Am Coll Cardiol 1985; 5:587-592). Serum levels of adhesion molecules were measured by enzyme-linked immunosorbent assay. RESULTS: Patients were divided into two groups according to the collateral degree (group A: 50 patients with grade 0 and 1; group B: 47 patients with grade 2 and 3 collaterals). The groups were well matched with respect to baseline clinical and angiographic characteristics. Levels of soluble VCAM-1 (mean+/-SEM; 875+/-26.6 versus 742.7+/-35.1 ng/ml; P=0.004), ICAM-1 (322.4+/-12.4 versus 269.4+/-13.3 ng/ml; P=0.005), and E-selectin (43.6+/-2.6 versus 33+/-2.4 ng/ml; P=0.004) were found to be significantly higher in group A in comparison with group B. In addition, when patients were divided into four groups according to the collateral degree, patients with grade 0 collaterals had the highest values and those with grade 3 collaterals had the lowest values for all these molecules. CONCLUSIONS: We concluded that poor collateral circulation is associated with increased levels of soluble CAMs in patients with obstructive coronary artery disease. However, further studies are needed to elucidate the exact role of these inflammatory markers in the setting of poor collateral circulation.

Collateral Circulation↗

PubMed1977

[Development of collateral circulation in the Paget-Schroetter syndrome].

An eleven years' clinical treatment of a 28-year-old tractor-driver with Paget-Schroetter's syndrome is described. The development of the collateral circulation was pursued during 6 years or 11 years, respectively, after the occurence of the vein thrombosis and the importance of phlebography in this rare disease is emphasized for the judgment of the prognosis. Phlebographic procedure is recommended for the reliable evaluation of the pathomorphological changes of the veins and of the developed collateral circulation.

Adult↗

PubMed1991

Collateral circulation in Kawasaki disease with coronary occlusion or severe stenosis.

Forty patients with Kawasaki disease with severe coronary sequelae were investigated. All had at least a 90% reduction in the diameter of the major coronary artery. Collateral vessels were seen in 32 of 33 (97%) patients with total occlusion. All patients with severe stenosis but not total occlusion had no or poorly developed collateral vessels. Analysis according to the presence or absence of collateral vessels showed no significant differences in the results of treadmill stress testing and myocardial imaging between these two groups. In patients treated surgically, the abnormalities recognized by these tests were normalized or improved when the bypass was patent. These data indicate that collateral circulation in patients with Kawasaki disease cannot be seen angiographically unless there is total occlusion and the presence of collateral circulation cannot provide protection against stress-induced myocardial ischemia.

Arterial Occlusive Diseases↗

PubMed2004

Retinal choroidal collateral circulation after radial optic neurotomy correlated with the lessening of macular edema.

PURPOSE: To evaluate patients who had undergone radial optic neurotomy for central retinal vein occlusion for the presence of retinal choroidal collateral circulation and to correlate these collaterals with changes in macular thickness during follow-up. Radial optic neurotomy is designed to release proposed pressure within the scleral canal. METHODS: Retrospective review of patients undergoing radial optic neurotomy. The patients had a baseline examination including ophthalmoscopy, fluorescein angiography, and optical coherence tomography. At an interval follow-up at approximately 3 months the patients were reevaluated with ophthalmoscopy, optical coherence tomography, and indocyanine green angiography. RESULTS: There were 6 patients, and the mean age was 68.3 years. The mean time from onset of the central retinal vein occlusion to the radial optic neurotomy was 2.3 months. One patient had no collateral vessels, three patients had significant collaterals, and two patients had moderate-caliber collaterals. The mean central macular thickness preoperatively was 1,021 microm and the mean central macular thickness postoperatively was 733 microm. The change in macular thickness was highly correlated with the degree of development of collaterals from the retinal to the choroidal circulation (P = 0.008, Spearman's rho = 0.93). CONCLUSION: Although all patients had a radial optic neurotomy a significant determinant in reduction of macular edema was the presence of retinal-choroidal collateral circulation. This suggests that there may be additional mechanisms, other than simple release of alleged pressure in the scleral canal, for any observed effects from radial optic neurotomy.

Aged↗

PubMed1995

Noninvasive evaluation of the collateral circulation to the hand.

OBJECTIVE: To compare four methods of evaluating collateral blood flow to the hand. METHODS: The hands of 74 volunteers on the faculty or staff of a university hospital were studied prospectively. Only subjects without known peripheral vascular disease were included. Four tests were used in random order to assess radial and ulnar artery flow. Results of the assessments using the modified Allen's test, pulse oximetry, plethysmography, and laser Doppler perfusion monitoring were compared. RESULTS: No interrupted palmar arch was found. The modified Allen's test was normal in all cases. Pulse oximetry detected a 5% incidence of noticeably reduced blood flow in one artery compared with the other artery. This dominance of one artery was identified in 69% of the hands by plethysmography. The laser Doppler noted a dominant artery in 64% of the hands. Plethysmography and the laser Doppler disagreed in their findings in only 9% of the hands evaluated. Numerical values of blood flow, attainable only by the laser Doppler, were significantly lower upon occlusion of the radial vs the ulnar arteries (p < 0.05; paired t-test). CONCLUSION: All of the tests provide information about the collateral circulation to the hand. Only the laser Doppler provides quantitative blood flow. Further studies involving subjects most at risk for post-cannulation ischemic injury are needed to guide the clinical application of these findings.

Adult↗

PubMedDate not supplied

[Effect of collateral circulation on myocardial perfusion using thallium-201].

BACKGROUND: The influence of collateral circulation (CC) on thallium-201 myocardial uptake was studied in 69 patients with coronary artery disease who underwent a coronary angiography. MATERIALS AND METHODS: According to Cohen and Rentrop a CC of 2nd and 3rd degree only was considered. A stress-early redistribution 201Tl scintigraphic protocol was utilized. The images were divided into five segments in each projection; the segments with higher uptake were considered as normal (100%). 1035 segments were analyzed and each segment was related to the donor artery on the basis of the 201Tl and angiographic evaluation. Patients were distinguished in single or multi-vessel disease with or without CC. In collateralized segments related to occluded or functionally more severe coronary stenosis, a somewhat significant prevalence of normal thallium-201 perfusion was observed, while in the non collateralized segments a higher prevalence of irreversible thallium defects was observed. CONCLUSIONS: The data suggest that CC is one of the factors responsible for the presence of normal scintigraphic images in patients with severe coronary stenosis or complete occlusion.

Angiocardiography↗

PubMed1981

Collateral circulation between the external and internal carotid artery.

The most important anastomoses between the arteria carotis externa and interna are discussed, based on a study of several patients with obstruction of the arteria carotis interna. When the arteria carotis interna is obstructed, it is important to determine, as best as possible, the collateral circulation to the vessels distal to the occlusion, since the prognosis can partly depend on it, and because collateral circulation must be taken into account in evaluating operative possibilities.

Carotid Arteries↗

PubMedDate not supplied

Post occlusion ischemia in the territory of the internal carotid artery: role of the ophtalmic collateral circulation in relation to the status of the bifurcation.

Recent studies of the literature indicate that arteriosclerotic lesions located in the remnants of bifurcation and proximally to an occluded internal carotid artery can represent sites for the origin of emboli. Through the collateral circulation, these emboli can reach the homolateral cerebral territories producing further ischemic events. Two groups of patient, with angiographically proven internal carotid artery occlusion, one with, and another without irregular arteriosclerotic lesions (IAL) in the stump and/or external carotid artery, were followed up in order to determine the frequency of delayed post-occlusion ischemic events in each group. Ipsilateral events occurred more frequently when there was a stump associated with IAL in the remnants of bifurcation and signs of ophtalmic collateral circulation. This association may have prognostic value and should be considered before performing bypass procedures.

Adult↗

PubMed1989

[Noninvasive imaging methods and angiography in the diagnosis of chronic viscero-visceral arterial collateral circulation in stenosis of the celiac trunk].

Stenosis or even occlusion of truncus coeliacus represents the most frequent cause in the development of collateral blood circulation with caudiocranial flow through extended pancreatic-duodenal arcades. In a group of 32 patients with such mesenteric-coeliacal collateral circulation their arteriographic picture was evaluated. The authors evaluated differences and specific diagnostic contribution of individual visualization methods for demonstration of arteries. The non-invasive visualization methods are of exceptional contribution in the examination of abdominoretroperitoneal region by considerably decreasing the needs of invasive angiographic examination of catheterization technique. This leads to a decrease in the number of diagnosed chronically developed viscerovisceral arterial collateral circulations of various etiologies. Ultrasonography and computer tomography well depicts morphological changes in the aorta diameter as well as unpaired visceral arteries in the segment of their branching. The viscerovisceral arterial collateral circulations, however, may not be detected or at least not to a sufficient degree. They are represented in detail in the whole course only by selective arteriography. The authors draw attention to supplementary role of arteriography within the framework of non-invasive visualization methods.

Adult↗

PubMed1991

Exercise training and coronary collateral circulation.

This review examines the potential for an exercise-induced increase in coronary collateral circulation, with specific reference to the role and functional significance of collateral vessels, highlighting animal and human studies in particular, and their inherent methodological limitations. Exercise training may enhance myocardial oxygen supply by promoting transient periods of myocardial ischemia, a potent trigger of collateral growth. Some human studies have shown that moderate-to-high intensity training can result in a higher double product at the onset of angina and/or ischemic ST-segment depression, suggesting that myocardial oxygen supply has increased. Attempts to use thallium-201 exercise scintigraphy to assess myocardial perfusion before and after a physical training program have produced conflicting data, whereas angiographic studies in group trials have, without exception, yielded disappointing results. Thus, direct evidence that exercise stimulates collateralization in humans is lacking.

Animals↗

PubMed1989

Assessing collateral circulation in the hand--four methods compared.

Four ways to assess the collateral circulation in the hand were compared. No correlation was shown between the Doppler ultrasound method and those that used either the pulse monitor or the Ohmeda Biox 3700 pulse oximeter. The study was unable to confirm suggested benefits of these methods in assessing adequacy of collateral flow in the hands of unconscious patients.

Collateral Circulation↗

PubMedDate not supplied

[The role fo collateral circulation in the course of coronary heart disease: 10-year clinical and angiographic follow-up].

The paper presents the results of a 10-year prospective follow-up of 59 patients with coronary heart disease (CHD) concurrent with functional classes II-IV angina pectoris. Coronarography was made in all the patients whose coronary arteries and collateral blood flow were assessed. The experimental group comprised 37 patients with CHD and collateral circulatory insufficiency. The control group included 22 patients with effective collateral circulation. The experimental group showed a worse prognosis than did the control one. Myocardial infarction developed in 54 and 27% of cases, coronary heart disease mortality was 29.7 and 9% in the experimental and control groups, respectively. Effective collateral circulation is a prerequisite of successful surgical myocardial infarction.

Angiography↗

PubMed1992

Takayasu's arteritis with collateral circulation from the right coronary artery to intracranial vessels--a case report.

A forty-four-year-old woman with Takayasu's arteritis and involvement of the aortic arch and its main branches complained of precordial pain on effort. Exercise electrocardiograms revealed significant ST segment depression in leads II, III, aVF, and V. Coronary arteriograms demonstrated no stenosis. However, the right coronary arteriogram revealed collateral circulation arising from the sinus node artery to the bilateral vertebral arteries and the left internal carotid artery. The collateral circulation was considered to be an important route of blood flow supply to the brain and, at the same time, a cause of coronary steal syndrome and, consequently, of angina pectoris.

Adult↗