ANGIOGRAPHIC AND CLINICAL-STUDY OF CORONARY COLLATERAL CIRCULATION

An anteriographic study has been made of the coronary collateral circulation of 100 consecutive patients who had complete occlusion of at least one coronary artery on coronary arteriography but who had contracting myocardium in the area once supplied by the occluded artery. Twenty-four additional patients were included who had coronary occlusion with a ventricular aneurysm. When there was contracting myocardium the distal end of the occluded artery which supplied it always filled with contrast material through collaterals and the better the myocardium contracted the more quickly and densely it filled and the more arterial branches were seen. Furthermore, the visibility of collateral was related directly to the density of filling of the obstructed segment of the coronary artery and to the quality of contraction of the myocardium in the distribution of the distal obstructed segment. By contrast in those with ventricular aneurysm, where contracting muscle was not seen in the peripheral distribution of the obstructed artery, the distal end of the obstructed artery filled slowly and poorly, had few branches and its collateral supply was not seen clearly. It is concluded that collateral vessels are functionally very important to the myocardium in the presence of coronary disease. The present study provides evidence in man that when coronary occlusion occurs whether an aneurysm develops or functioning myocardium remains depends on the presence of adequate collateral coronary circulation to the obstructed distal segment. © 1979 Dr. Dietrich Steinkopff Verlag.