Yoshio H, Shimizu M, Takeda R, Murakami T, Mifune J
Second Department of Internal Medicine, Kanazawa University School of Medicine, Japan.
Jpn Circ J. 1993 Aug;57(8):796-802. doi: 10.1253/jcj.57.796.
Three patients showed ST elevation on precordial electrocardiogram and ST depression on intracoronary electrocardiogram during angioplasty of the left anterior descending coronary arteries (LAD). While none of the patients had spontaneously visible collaterals, all showed transient recruitable collaterals to the LAD. No evident collaterals into the diagonal branches were observed. Possibly, if the intracoronary electrocardiogram represents the potential changes of the epicardial surface in the vicinity of the guidewire tip, then endocardial ischemia may have developed even though epicardial ischemia was not observed, due to relatively sufficient blood flow through the recruitable collaterals to the LAD. ST elevation on the precordial electrocardiogram may have represented epicardial and endocardial ischemia of the diagonal branches, where the recruitable collaterals could not protect against transmural ischemia. These phenomena suggests that the recruitable collaterals are functionally limited during acute coronary occlusion, even though the collaterals are well developed.
三名患者在左前降支冠状动脉（LAD）血管成形术期间，胸前心电图显示ST段抬高，而冠状动脉内心电图显示ST段压低。虽然所有患者均未自发出现可见侧支循环，但均显示LAD存在短暂可募集侧支循环。未观察到明显的侧支循环进入对角支。如果冠状动脉内心电图代表导丝尖端附近心外膜表面的潜在变化，那么尽管未观察到心外膜缺血，但由于通过可募集侧支循环向LAD的血流相对充足，可能已经发生了心内膜缺血。胸前心电图上的ST段抬高可能代表对角支的心外膜和心内膜缺血，可募集侧支循环无法防止透壁缺血。这些现象表明，即使侧支循环发育良好，在急性冠状动脉闭塞期间，可募集侧支循环的功能也是有限的。
