The Cardiovascular System and its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Myocardial infarction(MI) produces pain that is similar to angina pectoris, but the pain is usually much more severe. An infarction results from a thrombus (blood clot) or embolus (clot or other plug) blocking an artery sufficiently to produce necrosis. An MI results if the occlusion is in a coronary artery, thus affecting the myocardium. The extent of necrosis and the patient's prognosis depend largely on which artery is involved, the extent of occlusion, and the presence of collateral circulation. In a large transmural infarct (full thickness—transmural literally means "through the wall"), a large area of myocardium may necrose; if 40% or more of the left ventricular mass is infarcted, the heart is usually unable to pump effectively, and the patient will die of cardiogenic shock.
Arterial disorders
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Peripheral arterial stenosis or occlusion is predominantly caused by atherosclerosis and/or thromboembolic disease, but may also occur as a result of trauma, particularly in the younger adult. Stenosis or occlusion produces symptoms and signs that are related to the organ supplied by the artery: e.g. lower limb claudication, rest pain and gangrene; brain transient ischaemic attacks and stroke; myocardium angina and myocardial infarction; kidney hypertension and renal failure (Figure56.1); intestine abdominal pain and infarction. The severity of the symptoms is related to the size of the vessel occluded and whether the stenosis or occlusion occurs suddenly (acute) in a previously normal artery or gradually (chronic) with progressive narrowing of the artery over time. In chronic arterial narrowing, a collateral circulation may develop and provide an alternative route for blood flow that reduces symptoms until a critical stenosis or occlusion has developed (Figure56.2).
Coronary arterial anatomy: Normal, variants, and well-described collaterals
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
In the most common infantile presentation of this anom- aly, collaterals are inadequate to support the LV and the child presents with tachypnea, cough, wheezing, pallor, and cya- nosis. Signs of myocardial ischemia and anterior infarction with the associated complications of aneurysm formation, mitral regurgitation, and congestive heart failure are pres- ent.[82] Angiography is frequently necessary to confirm the diagnosis. Prompt surgical therapy is indicated as survival without surgery is <20% in symptomatic infants.[86] Some reports suggest that up to 20% of patients with this anomaly may survive into adulthood and remain asymptomatic or have a late presentation with mitral regurgitation, angina, or congestive heart failure (CHF).[87] Sudden death is a com- plication in both infants and adults. The clinical course of the patient tends to be more favorable if extensive collateral circulation exists.
Impact of collateral flow on true FFR prediction for left main coronary stenoses with downstream lesions
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
M. Lagache, R. Coppel, G. Finet, M. Malvé, R. I. Pettigrew, J. Ohayon
The Fractional Flow Reserve (FFR) is a clinical index of functional severity validated for isolated stenoses. FFR may be viewed as the ratio of achievable blood flow in a stenotic artery to the theoretic healthy flow in the same artery. FFR values < 0.75 lead to an insufficient blood irrigation of the myocardium, whereas FFR values > 0.80 are considered to be safe. A significant stenosis in the left main (LM) coronary artery is a dangerous configuration, commonly accompanied by downstream lesions in the daughter arteries and collateral flows. Collateral circulation is an alternative flow increasing total myocardial flow in obstructive coronary disease (Seiler et al. 2013). In these complex configurations, the individual apparent FFR, (True) of the LM stenosis in multiple stenoses configuration. This FFRTrue is the FFR of the the LM lesion if the downstream lesions were removed and is the true indicator of the severity of LM lesion. According to our knowledge, the proposed model is the first one to consider simultaneously: 1) LM stenoses with up to two downstream lesions, 2) the fractal geometry (as defined by Finet et al. 2010) of vascular trees, and 3) the influence of collateral circulation. The final goal of this model is to assist interventional cardiologists during decision making for revascularization for complex configurations.
Matrix metallopeptidase 9 and placental growth factor may correlate with collateral status based on whole-brain perfusion combined with multiphase computed tomography angiography
Published in Neurological Research, 2021
Bo Yang, Yarong Ding, Xin Liu, Yuan Cai, Xinxuan Yang, Qixuan Lu, Weibin Gu, Liping Liu, Yuehua Pu
Identifying the related factors and biomarkers of collateral circulation is the prerequisite to find treatment targets for improving collateral circulation. Differences of collateral assessment tools in studies may affect the consistency of the results on influence factors. Metabolic syndrome, hyperuricemia and older age [8] are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke [9]. Younger age, dyslipidemia and lower creatinine levels were predictors of better collaterals in acute ischemic stroke patients from proximal MCA occlusions [10]. Several serum biomarkers have proved to be correlated with coronary collateral circulation in patients with coronary artery disease. Neuregulin-1 [11], endostatin [12], YKL-40 [13] may be useful biomarkers for coronary collateral development and potential target for therapeutic angiogenesis in patients with coronary artery disease.
Dynamic observation on collateral circulation construction of patient with vertebral artery restenosis after stenting: case report
Published in International Journal of Neuroscience, 2021
Yan-Wei Yin, Qian-Qian Sun, Da-Wei Chen, Fa-Guo Zhao, Jin Shi
Collateral circulation system has major impact on the outcome of conservatively treated patients, and poor collateral circulation is related to worse outcome of larger infarcts in ischemic cerebrovascular disease. It is widely accepted that collateral circulation system can be divided into primary or secondary pathways [4]. Primary collateral pathway is the circle of Willis, whereas the ophthalmic artery and leptomeningeal vessels constitute secondary collateral pathways [4]. Furthermore, when the above common collateral circulations doesn't work, the third collateral pathway, neovascularization, will play their important role [5, 6]. Although it takes a long time to finish the third collateral circulation, the role is not negligible. Here, we report a patient who suffered from vertebrobasilar insufficiency and review the clinic and radiologic features of this entity. For two years we observe the whole process of the collateral circulation construction of this patient by digital subtraction angiography (DSA).
Related Knowledge Centers
- Circle of Willis
- Redundancy
- Retina
- Surgery
- Ischemia
- Circulatory System
- Blood Vessel
- Vascular Resistance
- Circle of Willis
- Neovascularization
- Moyamoya Disease