Human coronary collaterals are inter-coronary communications that are believed to be present
from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral
anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to
the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion
ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly
survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration
of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be
assessed by various methods. These coronary collateral channels have been used successfully as a retrograde
access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and
further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target
in patients with no suitable revascularization option is an exciting proposal.
Keywords: Arteriogenesis, chronic total occlusion, collateral, collateral flow index, percutaneous intervention.
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