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Open Access Review

The collateral circulation of the heart

Pascal Meier12*, Stephan H Schirmer3, Alexandra J Lansky2, Adam Timmis4, Bertram Pitt5 and Christian Seiler6

Author Affiliations

1 The Heart Hospital London, University College London Hospitals UCLH, London, UK

2 Division of Cardiology, Yale Medical School, New Haven, CT, USA

3 Department of Cardiology, University Hospital Saarland, Saarland, Germany

4 NIHR Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, London Chest Hospital, London, UK

5 Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI, USA

6 Department of Cardiology, University Hospital Bern, Bern, Switzerland

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BMC Medicine 2013, 11:143  doi:10.1186/1741-7015-11-143

Published: 4 June 2013

Abstract

The coronary arteries have been regarded as end arteries for decades. However, there are functionally relevant anastomotic vessels, known as collateral arteries, which interconnect epicardial coronary arteries. These vessels provide an alternative source of blood supply to the myocardium in cases of occlusive coronary artery disease. The relevance of these collateral arteries is a matter of ongoing debate, but increasing evidence indicates a relevant protective role in patients with coronary artery disease. The collateral circulation can be assessed by different methods; the gold standard involves intracoronary pressure measurements. While the first clinical trials to therapeutically induce growth of collateral arteries have been unavailing, recent pilot studies using external counterpulsation or growth factors such as granulocyte colony stimulating factor (G-CSF) have shown promising results.

Keywords:
Angiogenesis; Arteriogenesis; Coronary artery disease; Coronary collateral circulation