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Review
. 2014 Feb;10(1):65-72.
doi: 10.2174/1573403x113099990027.

Therapeutic approaches in the stimulation of the coronary collateral circulation

Achim Degen, Dominic Millenaar, Stephan H Schirmer  1
Affiliations
Review

Therapeutic approaches in the stimulation of the coronary collateral circulation

Achim Degen et al. Curr Cardiol Rev. 2014 Feb.

Abstract

Arteriogenesis as a way to restore blood flow after arterial occlusion has been under investigation for the treatment of coronary artery disease (CAD) for decades. Therapeutic approaches so far have included delivery of cytokines and growth factors as well as mechanical stimulation such as external counterpulsation. As knowledge on the mechanisms of arteriogenesis expanded, new therapeutic approaches have emerged. This review summarizes recent attempts to stimulate the growth of the coronary vasculature and discusses their potential in clinical application. This article also delivers an overview of current studies and trials on coronary arteriogenesis.

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Figures

Fig. (1)
Fig. (1)
Principle of ECP. During systole pressure cuffs, which are applied to the complete lower limb, are deflated allowing normal arterial blood flow in the lower limbs. During diastole cuffs are inflated to 300mmHg causing retrograde aortic blood flow and increased myocardial perfusion, consequently leading to an increase in coronary vascular shear stress.
Fig. (2)
Fig. (2)
Poor blood flow over small preexisting collateral arteries. The area distal of the occluded artery is not supplied sufficiently. Exercise leads to an increased blood flow in the native artery, causing increased flow in the collateral arteries and arteriogenesis. Blood flow in the occluded recipient artery is improved. External pressure as in ECP leads to increased collateral flow and arteriogenesis through diastolic augmentation, leading to an increase in blood flow in the recipient artery.
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