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PubMed1991

[Effect of the collateral circulation on myocardial salvage in patients with acute myocardial infarction].

The effects of the extent of coronary collateral circulations, the duration of myocardial ischemia and recanalization of infarct-related vessels on left ventricular function were evaluated in 43 patients with acute anteroseptal myocardial infarction. All patients had complete occlusions of their proximal left anterior descending coronary arteries and were treated with intra-coronary thrombolytic therapy within 8 hours after the onset of their chest pain. The 43 patients were categorized in 4 groups based on the extent of their coronary collaterals in the early period of myocardial infarction and the results of thrombolysis. Group A consisted of 11 patients with well-developed collaterals who had successful thrombolysis. Group B was comprised of 14 patients with poorly developed or no collaterals, and successful thrombolysis. In group C, there were 9 patients with well-developed collaterals and unsuccessful thrombolysis. In group D, there were 9 patients who had poorly or not developed collaterals, and all had unsuccessful thrombolysis. Four weeks after the intervention, ejection fraction (EF) and regional wall motion (RWM) were calculated from the data of the left ventricular angiograms. There was no significant difference in patients' age, sex, nor in peak serum creatine kinase among the 4 groups or the duration of myocardial ischemia between groups A and B. Patients with successful thrombolysis (groups A and B) had significantly higher EF and preserved RWM of infarct areas compared to patients with unsuccessful thrombolysis (groups C and D, p less than 0.05). Thirteen patients with early reperfusion (within 4 hours after the onset of chest pain) had significantly higher EF and better RWM than did 12 patients with late reperfusion and 18 patients with unsuccessful thrombolysis (p less than 0.01). However, there was no significant correlation between the duration of myocardial ischemia and RWM of the infarct areas among 25 patients who had successful thrombolysis (r = -0.3, NS). Patients in group A had higher EF and better RWM of infarct areas than did patients in groups B, C and D (p less than 0.01). In addition, 3 patients with well-developed collaterals had good RWM despite late reperfusion which occurred more than 4 hours after the onset of symptoms. These results suggest that the extent of coronary collaterals during the early period of myocardial infarction and the time delay from the onset of symptoms to the initiation of thrombolytic therapy are important factors for the salvage of left ventricular function in patients with myocardial infarction.

Aged↗
PubMedDate not supplied

Effects of collateral circulation on regional myocardial blood flow and left ventricular wall motion (A preliminary note).

The effect of collateral circulation on regional myocardial flow and wall motion of left ventricle was studied on 5 anesthetized dogs with a surgically implanted constrictor on the left circumflex coronary artery (LC). The grade of LC stenosis and wall motion of left ventricle (LV) were determined by cineangiography of the coronary artery and LV at the period of acute and chronic occlusion. Regional myocardial flow was determined by tracer microspheres (TM), labeled with four different isotopes, Sr85, Cr51, Sc46, Ce141. The first TM1 was infused after LC stenosis, TM2 during a temporary complete LC occlusion at the period of acute occlusion; TM3 and TM4 in a similar way 3 to 4 weeks after the acute LC stenosis. Three to four weeks after LC stenosis, i.e. chronic period of occlusion, the degree of LC stenosis progressed from 70--80% to 100% occlusion, but collateral flow and collateral vessels to the ischemic LC area were increased together with an improvement of wall motion of the ischemic LC area. The results may support the idea that collaterals may be an effective compensatory mechanism for ischemia. In contrast to an increase of collateral flow to the ischemic LV free wall in all five dogs, an increase to the posterior papillary muscle was found only in two out of five dogs.

Animals↗
PubMed1993

[Significance of hetero-collateral circulation in patients with chronic occlusion of the superficial femoral artery].

The authors examined a total of 11 lower extremities in 10 patients with chronic occlusion of the superficial femoral artery (mean length of occlusion 17.2 cm) in order to compare the participation of the heterocollateral and homocollateral circulation in the maintenance of the ankle pressures assessed by the Doppler principle. Before percutaneous transluminal recanalization of the chronic occlusion of the superficial femoral artery the authors induced by means of a balloon catheter short-term occlusion of the deep femoral artery in its central portion, closely after its insertion (complete block of the heterocollateral circulation) and in the periphery of this artery (partial block of the collateral circulation). During both types of balloon occlusion the authors assessed the ankle pressures and compared them with control values, assessed before occlusion. The authors found that in their patients the heterocollateral circulation, as compared with the homocollateral one, participated substantially more in the value of the ankle pressure at rest. The importance of the heterocollateral circulation increased with the length of chronic occlusion of the superficial femoral artery. In some patients the homocollateral circulation did not participate at all in the maintenance of the ankle pressure. A drop of the ankle pressure in patients with chronic occlusion of the superficial femoral artery is also more marked in acute occlusion of the deep femoral artery in its central portion, as compared with acute occlusion in the periphery.

Aged↗
PubMed2006

Serum level of lipoprotein (a) is inversely associated with the development of coronary collateral circulation.

BACKGROUND: This study sought to determine the relationship between serum lipoprotein (a) levels and angiographically visible coronary collateral circulation and to evaluate whether lipoprotein (a) exerts any effect on vascular endothelial cell growth factor. METHODS: The study population included 60 patients (39 men, mean age 59+/-13 years) with angiographically documented total occlusion in one of the major coronary arteries. Development of collaterals was classified by Rentrop's method. Patients were defined as having poorly developed collaterals for grades 0 and 1 (group 1), or well-developed collaterals for grades 2 and 3 (group 2). Serum lipoprotein (a) and vascular endothelial cell growth factor levels were determined by enzyme-linked immunosorbent assay. RESULTS: In group 1, lipoprotein (a) levels were significantly higher and vascular endothelial cell growth factor levels were significantly lower than in group 2 (34+/-19 vs. 20+/-12 mg/dl, P<0.001, and 2.5+/-0.7 vs. 3.4+/-0.8 ng/dl, P<0.001, respectively). Poorly developed collaterals were significantly more frequent in patients with lipoprotein (a) levels >or=30 mg/dl than in patients with levels <30 mg/dl (72 vs. 37%, P=0.008). A strong negative correlation was observed between lipoprotein (a) and vascular endothelial cell growth, factor (r=-0.708, P<0.0001). Multivariate analysis revealed that a high level of lipoprotein (a) negatively affected the development of collaterals, whereas the duration of angina had a positive effect. CONCLUSION: This study demonstrated for the first time that the high level of lipoprotein (a) negatively affects the formation of coronary collateral vessels in human beings. Reduced production or bioactivity of vascular endothelial cell growth factor caused by high levels of lipoprotein (a) may be the possible responsible mechanisms of hyperlipoprotein (a)-related poor collateral formation.

Adult↗
PubMed1997

Different mechanisms of ischemic adaptation to repeated coronary occlusion in patients with and without recruitable collateral circulation.

OBJECTIVES: The aim of this study was to investigate the interaction between ischemic preconditioning (IP) and collateral recruitment (CR) during ischemic adaptation in patients. BACKGROUND: The mechanism of ischemic adaptation still remains controversial in humans. METHODS: The clinical, electrocardiographic, hemodynamic and echocardiographic responses to three 150-s occlusions of the left anterior descending coronary artery were assessed in relation to CR in 18 patients with effort angina undergoing elective percutaneous transluminal coronary angioplasty. RESULTS: During the first occlusion, recruitable collateral circulation (RCC) to the occluded myocardium was detected by myocardial contrast echocardiography in 6 patients (Group C) and was not seen in 12 (Group N). In Group N, all patients manifested signs of severe ischemia during each inflation. However, their symptoms and ST segment shift significantly decreased from the first to the third occlusions, suggesting the occurrence of IP. The elevation of mean pulmonary artery pressure and deterioration of anterior wall motion were comparable between the first and the third occlusions in Group N. In contrast, myocardial ischemia was significantly less marked during occlusion in Group C than in Group N, and no preconditioning effect was observed. The extent of RCC did not differ between the first and the third occlusions in each group. CONCLUSIONS: Both IP and CR may play independent roles in ischemic adaptation in humans. With RCC, myocardial ischemia was greatly reduced. Without RCC, preconditioning clinically and electrocardiographically lessened myocardial ischemia but failed to preserve left ventricular function.

Angina Pectoris↗
PubMed1996

Angiographically assessed coronary collateral circulation increases vulnerability to myocardial ischemia during vasodilator stress testing.

In patients with a major coronary vessel occluded, the presence of good coronary collateral circulation increases vulnerability to myocardial ischemia induced by pharmacologic coronary vasodilation. The presence of good collaterals results in a greater frequency, severity, and extent of dipyridamole-induced regional left ventricular dysfunction, consistent with the hypothesis of angiographically assessed collaterals facilitating "steal phenomena" during dipyridamole-induced coronary vasodilation.

Aged↗
PubMed1982

Effect of physical training on coronary collateral circulation of the rat.

The influence of physical training on coronary collateral circulation following acute ligation of the left coronary artery was determined in pentobarbital-anesthetized rats. Coronary blood flows were determined with 15-microns microspheres during a wide range of perfusion pressures and during adenosine infusion. The demarcation between normal and ischemic tissue was achieved using nitroblue tetrazolium strain and thioflavin S fluorescence. Contractile performance was not altered by training, with the exception of a lower left ventricular end-diastolic pressure when afterload was elevated. Blood flow to and the size of the central ischemic zone were not influenced by training. However, in border zones, where collateral dependent flow is expected to be most pronounced, blood flow as a percent of normal was increased (16%, P less than 0.02) in trained animals. This increased was abolished by coronary vasodilation with adenosine. These results indicate that training caused a limited increase in collateral blood flow to the border zone. Further, tissue reactivity to adenosine following short periods of ischemia is normal in trained rats but decreased in border (11%) and ischemic (21%, P less than 0.05) zones in sedentary rats. Whether his small increase in blood flow to the border tissue, along with a retained capacity for dilatation, could lead to an improved salvage of tissue remains to be evaluated.

Adenosine↗
PubMed1990

Esophageal varices evaluated by endoscopic ultrasonography: observation of collateral circulation during non-shunting operations.

To clarify the inflow and outflow vessels of esophagogastric varices, we investigated the collateral circulation using endoscopic ultrasonography (EUS; Olympus GF-UM2, 7.5 MHz, radial type) during non-shunting operations in 16 cases of portal hypertension. The main inflow vessels were the left gastric veins and the short gastric veins. The paraesophageal vessels coalescent with esophageal varices were distributed up to 7 cm from the esophagogastric junction. It was possible to devascularize these inflow vessels from the transabdominal approach, and it was also easy to evaluate the complete devascularization by the intraoperative EUS. The main outflow vein seemed to be the azygos arch from the investigation of cross-sectional areas of the azygos system. EUS is very useful in evaluating portal hypertension and in determining the indications and the efficacy of the treatment.

Adult↗
PubMed1989

Vasomotor activity of moderately well-developed canine coronary collateral circulation.

This study examined the ability of moderately well-developed coronary collateral vasculature to undergo vasoconstriction in response to alpha-adrenergic agonists, vasopressin and angiotensin, and vasodilation in response to nitroglycerin. Studies were performed in 20 dogs 4-16 wk after left anterior descending coronary artery occlusion had been produced by an Ameroid constrictor or hollow intravascular plug. Collateral flow was estimated from retrograde flow from the cannulated left anterior descending artery. Tissue flow was measured with microspheres. Agonists were introduced into the left main coronary artery to reach collaterals arising from the left circumflex and septal arteries. Vasopressin and angiotensin II decreased retrograde flow from 22.7 +/- 5.5 to 15.5 +/- 2.7 and from 19.2 +/- 2.8 to 14.3 +/- 1.9 ml/min, respectively (each P less than 0.05). Both agents also significantly decreased tissue flow to normally perfused and collateral dependent myocardium. Neither the selective alpha 1-adrenergic agonist phenylephrine nor the alpha 2-agonist B-HT 933 decreased retrograde flow. Nitroglycerin increased retrograde flow by 63 +/- 27% (P less than 0.01). Thus, although the moderately well-developed coronary collateral circulation is capable of vasoconstriction in response to vasopressin and angiotensin II, these data fail to support a role for alpha-adrenergic mechanisms in modulating collateral flow.

Adrenergic alpha-Agonists↗
PubMed2002

Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction.

It is unknown if collateral circulation (CC) has a beneficial effect on outcomes of patients who undergo mechanical intervention in the first hours after onset of acute myocardial infarction (AMI). This study analyzes the relation between CC and outcome in patients with AMI who underwent primary angioplasty or stenting within 6 hours of symptom onset. The analysis was performed in a series of 1,164 consecutive patients. The contribution of clinical, angiographic, and procedural variables to the angiographic and clinical outcomes was evaluated by multivariate logistic regression analysis and the Cox proportional hazard model, respectively. Of 1,164 patients, 264 (23%) had angiographic evidence of CC. Patients with CC had a lower incidence of diabetes (11% vs 16%, p = 0.033), anterior AMI (41% vs 55%, p <0.001), cardiogenic shock (9% vs 14%, p = 0.029), anterograde TIMI grade flow >1 (10% vs 21%, p <0.001), and a greater incidence of preinfarction angina (43% vs 32%, p = 0.001), multivessel disease (59% vs 47%, p = 0.001), and total chronic occlusion (20% vs 10%, p <0.001). At 6 months, the mortality rate was lower in patients with CC compared with patients without CC (4% vs 9%, p = 0.011), whereas there were no differences in the incidence of reinfarction, target vessel revascularization, and angiographic restenosis. After multivariate analysis, CC did not emerge as a significant variable in relation to 6-month clinical and angiographic outcomes. CC does not exert a protective effect in patients who undergo mechanical intervention in the first 6 hours of AMI onset.

Angioplasty, Balloon, Coronary↗
PubMed1994

The effect of tecogalan sodium on the development of the collateral circulation after acute arterial occlusion.

The survival of tissues distal to major arterial occlusions is critically dependent on the development of collateral blood vessels. The biochemical events fundamental to their evolution remain undefined. To determine the role of endogenous basic fibroblast growth factor in the development of the collateral circulation we evaluated the dose response to Tecogalan Sodium (DS-4152) in a rat model of hind limb ischaemia. Treatment with DS-4152 inhibited the recovery following acute arterial occlusion and impaired limb viability. The inhibitory effects were more pronounced in the calf than in the adductor muscles and tended to be more marked in the groups treated with the higher dose regimens. The results provide further evidence that collateral development and tissue recovery following acute arterial occlusion are dependent on endogenous basic fibroblast growth factor and that this dependence is greater in the more ischaemic, distal tissues.

Acute Disease↗
PubMed2006

[Serum level of homocysteine and the development of collateral circulation in patients with severe coronary artery stenosis].

OBJECTIVE: To investigate the relationship between serum level of homocysteine and the development of collaterals in patients with severe coronary artery stenosis (SCAS). METHODS: Eighty patients with at least one vessel stenosis over 90% among the 3 main vessels of coronary artery were consecutively enrolled into the study according to angiographic estimation. The development of collaterals was classified by Rentrop's method. RESULTS: The serum levels of homocysteine among the single-vessel, bi-vessel and tri-vessel coronary artery disease groups had no significant difference; there was no linear correlation between the serum level of homocysteine and Gensini's score. The level of homocysteine in the poorly developed collaterals was significantly higher than that in the well-developed collaterals in the SCAS patients (P<0.001). Multiple stepwise logistic analysis revealed that homocysteine negatively correlated with the development of collaterals (P<0.001, odds ratio=0.353; 95% confidence interval=0.201 - 0.620), whereas it positively correlated with the number of stenosis vessels. CONCLUSION: The serum level of homocysteine is independently and negatively associated with the development of collateral circulation in severe SCAs patients.

Adult↗
PubMed1998

Improvement of exercise capacity by sarpogrelate as a result of augmented collateral circulation in patients with effort angina.

OBJECTIVES: The purpose of this study was to evaluate whether a serotonin blocker, sarpogrelate, improves exercise capacity as a result of vasodilation of coronary collateral channels in patients with effort angina. BACKGROUND: Serotonin has been reported to decrease coronary collateral blood flow by collateral vasoconstriction in a canine model, suggesting that platelet activation in feeding coronary arteries of the collateral network has the potential to cause collateral vasoconstriction. METHODS: The subjects consisted of 22 patients with effort angina and reproducible ischemic threshold (group A, 11 patients with thrombolysis in myocardial infarction (TIMI) grade 2 or 3 flow of the ischemia-related coronary artery and Rentrop's collateral index 0 or 1; group B, 11 patients with TIMI grade 0 or 1 flow and Rentrop's collateral index 2 or 3). We repeated the symptom-limited treadmill exercise test using the Balke-Ware protocol and exercise tetrofosmin myocardial perfusion scintigraphy with and without pretreatment with 200 mg orally administered sarpogrelate. Each exercise test was performed at 9:00 a.m. on different days. The order of tests with and without sarpogrelate was randomized. RESULTS: In group A, sarpogrelate increased neither exercise time at 0.1 mV ST depression nor double product at 0.1 mV ST depression. In contrast, in group B sarpogrelate increased the exercise duration at 0.1 mV ST depression from 181+/-112 (SD) to 248+/-131 s (p < 0.05) and also increased the double product at 0.1 mV ST depression by 21% (p < 0.01). The severity score using myocardial perfusion scintigraphy at the same workload was significantly (p < 0.01) decreased by 37% in group B, but not in group A (11%), due to the sarpogrelate treatment. CONCLUSIONS: Sarpogrelate augments flow reserve of the collateral circulation and improves exercise capacity in anginal patients with well-developed collaterals. These findings indicate that a serotonin blocker, sarpogrelate, is useful not only as an antiplatelet drugs, but as an antianginal drug.

Aged↗
PubMed2001

Intramyocardial delivery of basic fibroblast growth factor-impregnated gelatin hydrogel microspheres enhances collateral circulation to infarcted canine myocardium.

The present study examined whether basic fibroblast growth factor (bFGF)-impregnated acidic gelatin hydrogel microspheres (AGHM) would enhance collateral development to the infarct area in dogs with coronary occlusion. Studies were conducted in 28 dogs with a 2-week occlusion of the proximal left anterior descending coronary artery (LAD). The dogs were divided into 3 groups according to treatment: Group A treated with bFGF-impregnated AGHM in the infarct area; Group B with free-form bFGF; Group C with AGHM alone. Coronary angiography (n=15; Group A, 7 dogs; Group B, 5 dogs; Group C, 3 dogs) and a regional myocardial blood flow study (n=13; Group A, 6 dogs; Group B, 4 dogs; Group C, 3 dogs) were repeated at a 2-week interval. Coronary angiography revealed that in Group A, antegrade flow in the LAD distal to the occlusion, which was assessed by Thrombolysis in Myocardial Infarction (TIMI) grade, was significantly increased after treatment. In contrast, in Groups B and C, the treatment did not change the flow grade in the LAD. In Group A, the regional myocardial blood flow in the collateral dependent area was significantly increased after treatment, and the regional myocardial blood flow reserve after adenosine injection was also significantly increased. These measurements remained after treatment in Groups B and C. The immunohistochemical study with factor VIII-related antigen revealed an increase of vascular density in the ischemic region in Group A. Intramyocardial delivery of bFGF-impregnated AGHM, but not free-form bFGF, improves the collateral circulation to the infarct area of a coronary occlusion in dogs.

Animals↗
PubMed1994

The role of PDGF-BB on the development of the collateral circulation after acute arterial occlusion.

The survival of tissues in the presence of arterial occlusion is critically dependent on the development of collateral blood vessels. Identification of the biochemical mediators and their mechanism of action is fundamental to an understanding of the evolution of the collateral circulation. The ability of PDGF-BB to promote this was evaluated in an animal model of hind limb ischaemia. In order to obtain significant quantities of this mitogen for use in our animal model, human recombinant PDGF-BB was expressed in a Chinese Hamster Ovary (CHO) cell line. The transfected CHO cells produced 544 micrograms/l of PDGF-BB in serum free medium (SFM). The 30 kDa form of PDGF-BB was purified to homogeneity as judged by silver staining and amino-acid sequencing. Purified PDGF-BB was shown to be bioactive by a cell proliferation assay. The exogenous administration of PDGF-BB enhanced the recovery of blood flow after acute arterial occlusion. The results suggest that PDGF-BB may have therapeutic value in promoting collateral development following arterial occlusion.

Acute Disease↗