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Results for “COLLATERAL CIRCULATION”

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At least 37 records · Page 2Linked to original sources
PubMed2004

Reduced collateral circulation to the infarct-related artery in elderly patients with acute myocardial infarction.

OBJECTIVES: The purpose of this study was to investigate the hypothesis that circulation via collateral vessels to an infarct-related artery (IRA) is impaired with aging in patients with acute myocardial infarction (AMI). BACKGROUND: Animal experiments have shown that advanced age blunts the development of new vessels in response to angiogenic cytokines. METHODS: Of 3,573 consecutive patients with AMI, 1,934 patients who fulfilled the following criteria were enrolled in this study: 1) coronary angiograms were obtained within 72 h after the onset of AMI; and 2) IRA showed complete occlusion (Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 or 1). Collaterals to the IRA were angiographically evaluated using the Rentrop score. Rentrop scores 1 to 3 were defined as demonstrating significant collaterals. RESULTS: The prevalence of collaterals decreased with age, from 47.9%, 45.8%, 43.4%, to 34.0% in patients <50 years, 50 to 59 years, 60 to 69 years, > or =70 years, respectively (p < 0.001). Advanced age was an independent factor predicting the absence of collateral circulation to the IRA. In contrast, time to catheterization, history of angina pectoris, and preinfarction angina were independent predictors for the presence of collaterals. Multivariate analysis showed that the absence of collaterals was an independent predictor of in-hospital mortality in elderly patients > or =70 years (odds ratio, 15.6; 95% confidence interval, 3.5 to 69.6), although this finding was not significant in patients <70 years. CONCLUSIONS: Advanced age is associated with decreased angiographic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.

Age Factors↗
PubMed1990

Comparison of transcranial and cervical continuous-wave Doppler in the evaluation of intracranial collateral circulation.

Adequate intracranial collateral circulation reduces risk of stroke in carotid artery surgery. To evaluate their relative accuracies in assessing intracranial collateral blood flow, we prospectively compared transcranial Doppler and continuous-wave Doppler of the cervical carotid arteries combined with compression of the common carotid artery in 28 consecutive patients before carotid endarterectomy. Ten healthy volunteers served as controls. Three patients (11%) were excluded from compression of arteries because of diffuse disease in the common carotid artery. A total of 199 compressions were performed without complications. Lack of a suitable transtemporal window precluded the performance of transcranial Doppler in three patients (12%). The anterior communicating artery was identified in all the normal volunteers and 80% of patients by both methods. The posterior communicating artery was identified by both methods in 16 of 20 attempts in controls. Continuous-wave Doppler identified the posterior communicating artery in 30 of 50 attempts in patients; transcranial Doppler identified the posterior communicating artery in 20 of 44 attempts in patients (p greater than 0.5). Detection of intracranial collaterals correlated with intraoperative carotid artery back pressure measurements in 23 of 25 patients (92%). We conclude that continuous-wave Doppler of the extracranial arteries combined with common carotid artery compression is a safe and easy way to detect intracranial collaterals, with an accuracy equivalent to transcranial Doppler.

Adult↗
PubMed1978

Infarction and circulation in cerebrum. Effect of recanalization and/or collateral circulation on the lesion and prognosis.

Findings of computed tomography (CT) and angiography in supratentorial cerebral infarction associated with complete stroke were compared with regard to prognosis. It was found that the extent of low-density areas on CT was perfectly in accordance with the areas of occluded arteries on angiograms. However, the low-density areas on CT were always smaller than the areas involved angiographically when early recanalization and/or collateral circulation were carried out within 2 to 3 days of onset. It was also found that smaller low-density areas only had favorable effect. We concluded that the prognosis was better with early recanalization and/or collateral circulation, despite the general acceptance of its poor prognostic implication.

Adult↗
PubMed1991

[A study of collateral circulation in acute stage of occlusion of the middle cerebral artery].

Collateral circulation of angiogram in occlusion of main trunk of the middle cerebral artery in acute stage was studied in detail, and compared with the extent of the low density area on CT. Territory of the middle cerebral artery in the lateral view of angiogram was divided into three regions. Collateral circulation time was measured with the period from the maximum filling of carotid siphon to the retrograde maximum filling of collateral circulation. With these studies, the following conclusions were obtained. 1) The degree of collateral circulation is classified into three types. One type with good collateral circulation is type I. Another type with moderate collateral circulation is type II. A further type with poor collateral circulation is type III. Angiographic circulation time in each branch of the middle cerebral artery is measured in each type. 2) There is a tendency that types with the better development of collateral circulation have the smaller low density area on CT. In type I, the smallest low density area on CT appears in the territory of basal ganglia or around corona radiata. In type II or III, the medium or large low density area on CT appears in cortical and/or subcortical territory of the middle cerebral artery. 3) There is a tendency that types with the worse development of collateral circulation have the later collateral circulation time in each region. If collateral circulation time is later than 4 seconds, it is impossible to avoid the appearance of the low density area on CT in C region. In the same way, in B region, it is later than 5 or 6 seconds, in A region, it is later than 7 seconds. But, in type II or III, there are a few cases in which it is impossible to avoid the appearance of the low density area on CT, even if collateral circulation time is earlier than those mentioned. As mentioned above, classifying of collateral circulation is possible to expect the extent of the low density area on CT, and measurement of collateral circulation time is able to estimate the appearance of the low density area on CT. In type I and II, superficial temporal artery to middle cerebral artery anastomosis is apt to make the low density area narrow on CT, and to prevent the appearance of hemorrhagic infarction.

Acute Disease↗
PubMed1992

[The functional significance of coronary collateral circulation during sudden coronary occlusion].

The functional significance of the coronary collateral circulation remains controversial. It has been suggested that collateral circulation possibly helps prevent myocardial ischemia. Seventeen target lesions in 15 patients were studied to determine the relationship between the extent of the coronary collateral circulation and the degree of ventricular dysfunction during percutaneous transluminal coronary angioplasty (PTCA). During the first balloon inflation, diastolic indices such as left ventricular end-diastolic pressure, max negative dP/dt and the time constant of early relaxation were measured immediately before and at 60 sec following balloon inflation. During the second inflation, the contralateral and ipsilateral collateral circulations were evaluated. The latter was graded as follows: 0 = none; I = filling of side branches only; II = partial filling of the epicardial segment; and III = complete filling of the epicardial segment. Following balloon inflation, a significant increase was noted in the time constant of early relaxation in patients with grade 0 collateral circulation (40 +/- 7 to 47 +/- 7 msec: p < 0.01) and grade II collateral circulation (52 +/- 12 to 56 +/- 13 msec: p < 0.05). The percent increase in the time constant of early relaxation of patients with grade 0 and I collateral circulations exceeded that of patients with grade II (p < 0.05) or grade III collateral circulation (p < 0.05). Left ventricular end-diastolic pressure was elevated in all groups during PTCA. There was no significant difference in the percent increase of left ventricular end-diastolic pressure (LVEDP) between the 4 groups. However, LVEDP before PTCA was higher in patients with grade III collateral circulation than in patients in the other groups. Max negative dP/dt did not change significantly in any group. In conclusion, collateral circulation helps prevent myocardial ischemia during acute coronary occlusion, which is most precisely shown by the time constant of early relaxation. The degree of this protective function of collateral circulation seems to vary.

Aged↗
PubMedDate not supplied

Coronary collateral circulation in the pig: correlation of collateral flow with coronary bed size.

Coronary bed sizes were measured in pigs. The left anterior descending bed occupies about 31% of the heart, the right coronary bed about 38% of the heart and the left circumflex bed about 31% of the heart is (including atria). The right coronary artery supplies about 81% of the right ventricle and 23% of the left ventricle with its blood supply. The remaining portion of the right ventricle is supplied by the LAD. The collateral circulation was measured in each of the 3 coronary beds using tracer microspheres. Measurements, are in ml/min/100 g. Transmural collateral flow in the LC is 5.6, the LAD 1.0, the RC in LV 3.7 and the RC in RV 4.3. Our experiments showed that the coronary bed sizes were relatively uniform in pigs, but that collateral flow was significantly different between the beds.

Animals↗