Clinical and Experimental Studies on Angiogenesis of Coronary Collateral Vessels

冠状动脉侧枝循环的临床意义我们发现，梗死前心绞痛但溶栓不成功的患者（67%）和既没有梗死前心绞痛又没有再通的患者（13%）发生梗死后心绞痛的比例有显著差异。这表明，伴随梗死前心绞痛的发达侧支循环使心肌组织在梗死相关冠状动脉的灌注区域存活，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，梗死相关冠状动脉侧支循环明显且再灌注不成功，只有1例患者（10%）观察到左心室动脉瘤，而在12例再通不成功且没有明显侧支灌注的患者中，左心室动脉瘤形成的发生率明显更高（7/12,58%）。这些结果表明，发达的侧支循环可以预防左心室动脉瘤的形成，可能是因为梗死区残存的心外膜下细胞岛对梗死扩张有有益的功能作用。在稳定苦力型心绞痛患者中，肝素预处理运动明显提高了运动能力，并增加了受损心肌旁络的混浊程度。这种治疗方式的发展可能会减轻由冠状动脉疾病引起的有害后遗症。心肌缺血对冠状动脉侧枝循环的影响我们报道了心肌缺血对天然侧枝循环募集的重要性。冠状动脉闭塞51 min或5 min后的侧支血流明显大于30 10sec后的侧支血流，两者的总闭塞时间相同。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。用数学方法评估冠状动脉闭塞的第1分钟和第2分钟对侧枝发育的相对贡献。冠状动脉闭塞后1分钟的疗效是第1分钟的4.43倍。由于冠脉闭塞后1 min心肌缺血程度较严重，因此认为严重缺血对侧枝发育至关重要。我们的数据表明心肌缺血对冠状动脉侧枝循环的募集和发展都很重要。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