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Coronary collateral circulation

Bruce D Klugherz, MD
Daniel M Kolansky, MD
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Gordon M Saperia, MD, FACC


Anastomotic channels, known as collateral vessels, can develop in the heart as an adaptation to ischemia [1,2]. They serve as conduits that bridge severe stenoses or connect a territory supplied by one epicardial coronary artery with that of another [3]. Collaterals therefore provide an alternative source of blood supply to myocardium jeopardized by occlusive coronary artery disease, and they can help to preserve myocardial function in the setting of a chronic total coronary occlusion [4].

Two classes of collateral vessels have been recognized:

Capillary size collaterals, in which smooth muscle cells are absent, may be observed throughout the myocardium, although they have a predilection for the subendocardium.

Larger, muscular collaterals, which develop from pre-existing arterioles, are typically located epicardially [5].


The clinical and pathophysiologic determinants of collateral recruitment are poorly understood. Although primarily thought to be initiated by ischemia, appreciable collateral perfusion is present in some patients who do not have coronary disease [6].


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Literature review current through: Sep 2016. | This topic last updated: Jul 15, 2015.
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