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At least 415 records · Page 23Linked to original sources
PubMed1983

Krypton-81m single photon emission tomography and the collateral circulation in carotid occlusion: the role of the circle of Willis and leptomeningeal anastomosis.

Cerebral perfusion images were investigated in patients with carotid artery occlusion, using single photon emission computed tomography with the infusion of krypton-81m into the internal, common carotid and vertebral arteries. The contribution of the circle of Willis and cerebral cortical anastomoses to the maintenance of adequate blood supply into the involved hemisphere was analysed. It was concluded that the cerebral perfusion image is superior to angiography in evaluating collateral circulation, and in the case of carotid occlusion, the circle of Willis is important in preventing infarction in the territory of the perforating arteries, while the cerebral cortex mainly receives its blood supply through the cortical leptomeningeal anastomoses, illustrating the major role of the leptomeningeal anastomosis as a collateral channel.

Adult↗
PubMed1987

Species variation in the coronary collateral circulation during regional myocardial ischaemia: a critical determinant of the rate of evolution and extent of myocardial infarction.

To determine residual flow to ischaemic tissue, which is the primary determinant of the rate of development and ultimate size of the myocardial infarct resulting from coronary artery occlusion, the coronary collateral circulation was quantified during acute myocardial ischaemia in eight species in vivo using the radiolabelled microsphere technique. In each case, a prominent branch of the left coronary artery was ligated, and within 5 min microspheres (141Ce labelled, 15 micron diameter) were injected intra-atrially. Hearts were then excised, frozen, and sliced perpendicular to the septum. Using autoradiograms as a guide, tissue samples were obtained from non-ischaemic and ischaemic tissue and the radioactivity of the ischaemic samples measured and expressed as a percentage of the activity in the non-ischaemic myocardium. In the guinea pig heart, despite ligation of a major artery, no zone of significant underperfusion was detected. In the hearts from other species, coronary collateral flow (as a percentage (mean(SEM)) of non-ischaemic flow) was: dog 15.9(1.8) (n = 6); cat 11.8(1.1) (n = 16); rat 6.1(0.7) (n = 6); ferret 2.4(0.6) (n = 6); baboon 2.1(0.3) (n = 6); rabbit 2.0(0.5) (n = 9); pig 0.6(0.2) (n = 6). The dog and cat hearts both possessed transmural gradients of collateral flow with greatest delivery in the epicardium. The patterns of flow distribution in the guinea pig heart were further examined in a Langendorff perfused preparation. Blue dye was injected into the coronary circulation and its distribution over 5 s recorded on cine film. After ligation of the left anterior descending or circumflex arteries, or both, the perfusion field of these arteries was seen to fill retrogradely within seconds. It is concluded that a wide spectrum of collateral flow exists between various mammalian species, a fact that should be taken into account in the study of the pathophysiology and control of regional ischaemia and myocardial infarction.

Animals↗
PubMed2003

Markers of myocardial ischemia in the evaluation of the effect of left anterior descending coronary artery lesion and collateral circulation on myocardial injury in 1-vessel off-pump coronary bypass surgery.

BACKGROUND: The purpose of this study was to use serum markers for myocardial tissue damage to evaluate the effect of the severity of left anterior descending artery (LAD) lesions after 1-vessel off-pump coronary artery bypass grafting. METHODS: A consecutive series of 20 patients with a totally occluded LAD and only retrograde filling (group T; n = 10) or critical stenosis (70%-99%) and only antegrade filling (group C; n = 10) were included in this study. One patient in group C who displayed no increases in the levels of markers for myocardial ischemia was excluded from the study because of the intraoperative repetition of the anastomosis. Creatine kinase activity (CK), CK-MB activity, and CK-MB mass, myoglobin, lactate, and cardiac troponin I (cTnI) concentrations were determined in venous blood samples taken immediately before and after the anastomosis and at 4, 8, 12, 24, and 48 hours postoperatively. RESULTS: There were no perioperative myocardial infarctions. One patient in group T developed low cardiac output syndrome 48 hours after the operation and died after 1 month. His enzyme levels did not increase in the first 2 days postoperatively. Anastomosis times were similar for the T and C groups (6.85 +/- 0.9 minutes versus 8.4 +/- 2.2 minutes, respectively; P =.069). The levels of all cardiac markers except cTnI increased significantly in the first 24 postoperative hours. CK-MB activity, CK-MB mass concentration, and cTnI concentration were not different between the 2 groups. Four patients in each group were evaluated for the patency of the anastomosis, and all control angiography and myocardial scanning tests showed patent anastomoses and no ischemia. CONCLUSIONS: One-vessel off-pump coronary artery bypass grafting can be performed safely in patients with serious LAD stenosis and borderline antegrade blood flow without the need for any coronary collateral circulation support. A short anastomosis time prevents myocardial injury during off-pump coronary surgery.

Adult↗
PubMedDate not supplied

Assessing adequacy of collateral circulation during balloon test occlusion of the internal carotid artery with 99mTc-HMPAO SPECT.

A balloon test occlusion of the internal carotid artery was performed in 11 patients with internal carotid artery aneurysms. Tolerance by patients was assessed by a combination of clinical examination; angiography; electroencephalography; 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) with relative quantification; and, in four patients, 99mTc-HMPAO SPECT with absolute quantification of cerebral blood flow. During test occlusion, angiography showed a patent circle of Willis in all patients. No patient developed new clinical findings or electroencephalographic changes. The SPECT studies of five patients in whom 99mTc-HMPAO was injected during test occlusion demonstrated changes from their baseline SPECT studies. The internal carotid artery was permanently occluded in two of these patients, neither of whom became symptomatic because of the occlusion. Three patients who demonstrated no changes between baseline and test occlusion SPECT studies underwent permanent occlusion of the internal carotid artery without incident, and postoperative SPECT images were unchanged from baseline. Our preliminary results suggest that patients who have no changes between baseline and test occlusion 99mTc-HMPAO SPECT studies should have adequate collateral circulation to sustain cerebral blood flow after occlusion of the internal carotid artery if no thromboembolic episodes occur. In contrast, a patient's tolerance of permanent occlusion cannot be consistently and reliably predicted if there are changes between baseline and test occlusion SPECT studies. In these patients, absolute quantitation of cerebral blood flow is important. Greater numbers of patients are required to confirm these initial results.

Carotid Artery, Internal↗
PubMed1994

[Collateral circulation of cerebral hemispheres in occlusive lesions of carotid arteries].

The collateral blood supply to the cerebral hemispheres was studied in 58 patients with occlusive diseases of the carotids on an ultrasonic apparatus based on an undamped wave with a beam frequency of 4 and 8 MHz by appraising the character of the blood flow in the supratrochlear artery in compression of the ipsilateral common carotid artery. The disease was caused by atherosclerosis in 32 and by nonspecific aortoarteritis in 26 patients. Correlation of the character of the blood flow in the supratrochlear artery in compression of the ipsilar common carotid artery and the quantitative value of retrograde pressure in the internal carotid artery showed that the retrograde pressure in the internal carotid in patients with a safe residual antegrade flow of blood in the supratrochlear artery was significantly higher in compression of the ipsilar common carotid artery than in reduced and retrograde blood flow and was 70 +/- 12.6 mm Hg, 33 +/- 12.4 mm Hg, and 34 +/- 10.7 mm Hg, respectively.

Adult↗
PubMed2004

Anomalous origin of the left coronary artery from the pulmonary artery in an adult with systemic collateral circulation to the left coronary artery.

A case of anomalous origin of the left coronary artery from the pulmonary artery in an adult with collateral circulation between the left coronary artery and systemic extracardiac vessels is reported. After evaluating the surgical options, my colleagues and I conclude that ligation of the left coronary artery and a left internal thoracic artery graft to the left anterior descending coronary artery is the preferable option for treating such patients.

Adult↗
PubMed1993

Coronary collateral circulation in the transplanted heart.

BACKGROUND: The concept that coronary collateral (CC) circulation can develop in cardiac transplant recipients (CTR) is controversial. Indeed, a decreased occurrence of CC in CTR has been previously reported. METHODS AND RESULTS: We reviewed 102 coronary angiograms in 73 CTR to evaluate the presence and significance of CC in denervated human hearts. These angiograms were compared with angiograms of 70 nontransplanted patients. Twenty-six CTR who had undergone at least two coronary angiograms, thus allowing comparative evaluations, form the basis for this study. Angiograms were analyzed using a modification of CC classification (Rentrop et al) from grade 0 for complete absence to grade 4 representing mature collateral with clear filling of epicardial vessels. Coronary artery disease was classified according to the scheme reported by Gao et al. For the purpose of this study, all type A lesions were grouped as large vessel disease (LVD), and types B1, B2, and C were collectively grouped as small vessel (epicardial) disease (SVD). The presence of CC circulation in all 73 CTR was grade 0, 7 (10%); grade 1, 41 (56%); grade 2, 33 (45%); grade 3, 30 (41%); and grade 4, 5 (7%). However, in control nontransplanted subjects grades 0, 1, 2, 3, and 4 were found in 47 (67%), 22 (31%), 4 (6%), 11 (15%), and 16 (20%) patients, respectively. The presence of mature collaterals (grade 4) in both groups were associated with type A lesions and was frequent in nontransplanted hearts. In contrast, grade 2 and grade 3 vascular channels probably representing CC with "myocardial blush" was more frequent in CTR and was mostly associated with small vessel coronary arteriopathy. CONCLUSIONS: These results suggest the presence of atypical CC in patients with cardiac allograft arteriopathy. It is speculated that this atypical form of CC with "blush pattern" may represent an angiogenic response to microvascular ischemia due to allograft coronary arteriopathy.

Adult↗
PubMed2001

Correlation between the haemodynamics of portal collateral circulation and the incidence of esophageal bleeding in patients with portal vein thrombosis--a preliminary report.

The aim of this study was to determine a correlation between the haemodynamics of portal collateral circulation (PCC) and the incidence of bleeding episodes. The prospective analysis included 17 patients with portal hypertension resulting from prehepatic block but without history of oesophageal bleeding. Every two months the changes in PCC and incidence of oesophageal bleeding were evaluated. The follow-up ranged from 3 to 12 months. The statistical correlation between the portal haemodynamic disorders and the tendency to bleed was investigated. Variceal bleeding occurred in 6 patients during the time of observation, mostly in patients with development of hepatofugal PCC. Authors suggest that the development of hepatofugal PCC is the main factor of variceal bleeding in patients with portal vein thrombosis (PVT).

Esophagus↗
PubMed1975

Radiological topography and classification of angioma-like arterial networks in cerebro-vascular collateral circulation.

The radiological appearance and localization of collateral cerebrovascular networks are described. The development and distribution of these arterial networks is due to the site of internal carotid artery stenoses. Including interposed arterial nets, the following types are classified: (1) basal arterial networks near the carotid siphon; (2) arterial networks in the region of the basal ganglia (Moyamoya syndrome); (3) ethmoid arterial networks; (4) arterial networks on the cerebral convexity representing transdural external-internal carotid anastomoses, and (5) circumscribed arterial networks interposed in the course of a major cerebral vessel. The differential diagnostic criteria and aetiological factors of these anastomotic intracranial networks are discussed.

Brain Neoplasms↗