Clinical and Experimental Studies on Angiogenesis of Coronary Collateral Vessels

冠状动脉侧支循环的临床意义我们发现，梗死前有心绞痛但溶栓失败的患者（67%）与梗死前既无心绞痛也无再通的患者（13%）中，梗死后心绞痛的比例有显著差异。这表明，发达的侧支循环伴随梗死前心绞痛使心肌组织在梗死相关冠状动脉的灌注区域中存活，并由于其有限的血流储备而导致梗死后心绞痛。我们还证明，在10例急性心肌梗死患者中，有明显的梗死相关冠状动脉侧支循环和不成功的再灌注，只有1例患者（10%）观察到左室壁瘤，而在12例无明显侧支灌注的不成功再通患者中，发生率明显较高（7/12，58%）的le ...更多信息 室壁瘤形成。这些结果表明，发达的侧支循环可以防止左室壁瘤的形成，可能是因为有益的功能作用，在梗死区的残余的心外膜下细胞的活性岛梗死扩展。在稳定型劳力型心绞痛患者中，肝素预处理运动明显改善了运动能力，并增加了受损心肌侧支循环的浑浊程度。这种治疗方式的发展可能会减轻由于冠状动脉疾病的有害后遗症。心肌缺血冠状动脉侧支循环的影响我们报道了心肌缺血对募集天然侧支循环的重要性。冠状动脉闭塞5 ~ 1 min或5 min后的侧支血流明显大于闭塞30 ~ 10 sec后的侧支血流，而闭塞时间相同。我们比较了重复1分钟或2分钟冠状动脉闭塞对侧支循环发展的影响。用数学方法评价冠状动脉闭塞的第一和第二个1分钟对侧支循环发展的相对贡献。冠状动脉闭塞的第二个1 min是闭塞的第一个1 min的4.43倍。由于心肌缺血的程度在冠状动脉闭塞的第二个1分钟内更严重，因此可以得出结论，严重缺血对侧支循环的发展至关重要。我们的数据表明心肌缺血对冠状动脉侧支循环的募集和发展的重要性。少

Clinical significance of Coronary Collateral CirculationWe found that there is a significant difference in the proportion of patients with post-infarction angina between those with pre-infarction angina but unsuccessful thrombolysis (67%) and those who had neither pre-infarction angina nor recanalization (13%). This suggests that the developed collateral circulation accompanying pre-infarction angina renders myocardial tissue viable in the perfusion territory of the infarct-related coronary artery and causes post-infarction angina because of its limited flow reserve. We also demonstrated that in 10 patients with acute myocardial infarction who had a significant collateral circulation to the infarct-related coronary artery and unsuccessful reperfusion, the left ventricular aneurysm was observed in only one patient (10%), while in 12 patients with unsuccessful recanalization in the absence of a significant collateral perfusion, there was a significantly higher incidence (7/12, 58%) of le … More ft ventricular aneurysm formation. These findings indicate that the well-developed collateral circulation can prevent the left ventricular aneurysm formation probably because of a salutary functional effect of viable islands of residual subepicardial cells in the infarct zone on infarct expansion. In patients with stable effort angina, exercise with heparin pretreatment definitely improved the exercise capability associated with an increase in the extent of opacification of collaterals to the jeopardized myocardium. The development of such a therapeutic modality may attenuate the deleterious sequelae due to coronary artery disease.Effects of Myocardial Ischemia Coronary Collateral CirculationWe reported the importance of myocardial ischemia for the recruitment of a native collateral circulation. The collateral flow after 5 1 min or a 5 min coronary occlusion was significantly qreater than after 30 10 sec coronary occlusions, where the total occlusion time was identical. We compared the effects of repeated 1 min or 2 min coronary occlusions on the development of collateral circulation. The relative contribution of the first and second 1 min of coronary occlusion to the collateral development was mathematically evaluated. The second 1 min of coronary occlusion was 4.43 fold more effective than the first 1 min of occlusion. Because the extent of myocardial ischemia is more severe during the second 1 min of coronary occlusion, it was concluded that severe ischemia is crucial for the collateral development. Our data indicated the importance of myocardial ischemia for both recruitment and development of coronary collateral circulation. Less