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European Heart Journal Advance Access originally published online on October 17, 2005
European Heart Journal 2005 26(23):2595; doi:10.1093/eurheartj/ehi515
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Coronary collaterals

Marc Dewey1,* and Hans-Peter Dübel2

1Department of Radiology, Charité, Medical School, Freie Universität and Humboldt-Universität zu Berlin, Schumannstr. 20/21, 10117 Berlin, Germany
2Department of Cardiology, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Berlin, Germany

* Corresponding author. E-mail address: marc.dewey{at}charite.de

A 79-year-old man with onset of typical angina pectoris was referred to our institution for suspected coronary artery disease. We performed non-invasive coronary angiography using a 16-slice computed tomography scanner with 0.5 mm slice width (Aquilion 16, Toshiba, 0.35x0.35 mm2 in-plane resolution, 12.9 mSv) after intravenous application of 110 mL of an iodinated contrast agent (Visipaque 320, GE-Healthcare Biosciences). The virtual angioscopy performed on the basis of this examination revealed that a large calcified plaque totally occluded the proximal segment of the left anterior descending artery (arrow in Panel A). Volume-rendered reconstructions showed coronary collaterals from the right coronary artery to the left anterior descending artery (arrows in Panel B), which bypassed the occlusion of the left anterior descending artery and thus limited damage to this myocardial territory. Conventional coronary angiography (Panel C) was performed on the same day and confirmed the presence of collaterals from the right to the left coronary artery system (arrows). The patient subsequently underwent bypass surgery. Six months after coronary artery bypass grafting, the patient was doing well and follow-up multi-slice computed tomography showed arterial and venous bypass grafts without stenoses, while the left internal mammary artery graft bypassed the occlusion of the left anterior descending coronary artery, and the right-to-left coronary collaterals were no longer present (Panel D). With the high spatial resolution of multi-slice computed tomography, even coronary collaterals as an indirect sign of coronary occlusions can be identified non-invasively.

See online supplementary material available at European Heart Journal online for a colour version of this figure.


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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow HTML Page - index.htslp
Right arrow All Versions of this Article:
26/23/2595    most recent
ehi515v1
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