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Q J Med 2004; 97: 259-272
QJM vol. 97 no. 5 (c) Association of Physicians 2004; all rights reserved.

Review

Collateralization and the response to obstruction of epicardial coronary arteries

M.H. Tayebjee, G.Y.H. Lip and R.J. MacFadyen

From the Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

Occlusive coronary disease is an important cause of global morbidity and mortality. While mechanical revascularization is effective, some individuals are not amenable to such interventions, and have a poorer prognosis. However, collateral circulation can protect and preserve myocardium around the time of coronary occlusion, contribute to better residual myocardial contractility, and lessen symptoms. We describe the anatomy and physiology of coronary collateralization, its component parts (angiogenesis and arteriogenesis), the current methods for definition of the collateral response and how this might be manipulated. The manipulation of this process is a realistic possibility for future adjuvant treatment of coronary artery disease.

Address correspondence to Dr R.J. MacFadyen, University Department of Medicine, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QU. e-mail: robert.macfadyen{at}swbh.nhs.uk


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