The human coronary collateral circulation

Cardiovascular diseases, in particular coronary artery disease (CAD), are the leading cause of death in industrialised countries. Established options for revascularisation include angioplasty and surgical bypass, both of which are not suitable in 20-30% of patients in whom the extent of coronary atherosclerosis is especially severe. An alternative treatment strategy for revascularisation is therefore warranted both to control symptoms as well as to alter the course of advanced CAD. An ideal candidate to fill in this gap is therapeutic promotion of coronary collateral growth - that is, the induction of natural bypasses. In order to reach this goal, a comprehensive understanding of the human coronary collateral circulation with regard to its relevance, accurate assessment, the pathogenetic and pathophysiological aspects, and the different therapeutic options is mandatory.