Wainwright R J, Maisey M N, Edwards A C, Sowton E
Br Heart J. 1980 Jan;43(1):47-55. doi: 10.1136/hrt.43.1.47.
Sixty-five patients with angiographically documented coronary artery disease were investigated by thallium-201 (201Tl) scintigraphy to determine the role of the collateral circulation during dynamic exercise. Fifty-three patients had complete proximal occlusion of at least one major coronary artery. One patient had total occlusion of all three major coronary arteries. Sixty-four collateral channels were identified, graded, and compared with corresponding regions of the myocardial scintigram. Tracer uptake was also graded and classified as various degrees of protection from ischaemia. A significant correlation between good collaterals with complete protection and poor or absent collaterals with no protection was noted. Seventeen patients (20 occluded vessels) had total coronary occlusion without myocardial infarction. Collaterals conferred protection in 9/15 occlusions whereas no protection was seen in five occlusions without collaterals. There was no difference in the protective role of homocoronary and heterocoronary collateral vessels. Hypertrophy of the first septal left anterior descending perforator conferred significant protection from ischaemia in contrast to bridging collaterals and ghosting. During exercise the right coronary bed is preferentially protected from ischaemia, in contrast to the left anterior descending territory. This probably reflects the direction of a transmural flow gradient between left and right ventricles during exercise.
对65例经血管造影证实患有冠状动脉疾病的患者进行了铊-201（²⁰¹Tl）闪烁扫描，以确定侧支循环在动态运动中的作用。53例患者至少有一支主要冠状动脉近端完全闭塞。1例患者三支主要冠状动脉全部闭塞。共识别出64条侧支血管，进行了分级，并与心肌闪烁图的相应区域进行了比较。示踪剂摄取也进行了分级，并分类为不同程度的缺血保护。发现具有完全保护作用的良好侧支与无保护作用的不良或无侧支之间存在显著相关性。17例患者（20支闭塞血管）存在冠状动脉完全闭塞但无心肌梗死。侧支在9/15例闭塞中起到了保护作用，而在5例无侧支的闭塞中未观察到保护作用。同冠状动脉和异冠状动脉侧支血管的保护作用没有差异。与桥接侧支和幻影侧支相比，第一间隔左前降支穿支的肥大对缺血有显著的保护作用。在运动过程中，与左前降支区域相比，右冠状动脉床优先受到缺血保护。这可能反映了运动期间左右心室之间跨壁血流梯度的方向。
