collateral circulation

My husband has had 3 CABG, approx. 10 stents. His EF is 30%, ant & inf. are hpyokinetic, apex is akinetic.
All of the stents and grafts are occluded except for SVG (99%) before stent. and one graft is 90%.
Can he develop more collaterals now? He is 71 years old and very active.

[kenkeith]

Although there is not conclusive evidence tests have findings that collateral vessel development is poorer in obese patients (defined as BMI (calculation based on height/weight...normal 18.5-24.9; obesity 30 or greater) with ischemic heart disease compared to normal range BMI, and the risk of having poor collateral vessel development is significantly increased. However, this might be associated with metabolic syndrome, in which insulin resistance plays a major role.

For some insight the formation of coronary collateral vessels is a compensatory mechanism secondary to repetitive or chronic myocardial ischemia. During the past three decades the functional and prognostic benefit of such collateral vessels has been established. There are large interindividual differences in the number and extent of collateral vessels that may be explained by differences in the anatomic situation or by differences in the individual capacity to develop functional collateral vessels. Diabetes mellitus has recently been identified as one of the first negative predictors of collateral vessel formation.
  
  Development of coronary collaterals (CCs) is triggered by the gradient between arteries due to obstruction and myocardial ischemia. Presence of CCs that feed the jeopardized myocardial area may limit the infarct size after coronary occlusion and may even provide a survival benefit. However, some patients develop good CCs, whereas others do not. The metabolic syndrome (MS) has been identified as a secondary target to decrease cardiovascular risk, although the effect of MS on development of CCs has not been investigated. We prospectively enrolled 596 consecutive patients (337 men and 259 women; mean age 56 ± 8 years) who underwent coronary angiography at our center and were found to have total occlusion of the right coronary artery. Patients were then classified as having good CCs (Rentrop’s grades 2 to 3) or poor CCs (Rentrop’s grades 0 to 1). There were significant differences in terms of body mass index (kilograms of body weight divided by square meters of height), glucose levels, triglyceride levels, and years with angina pectoris between those with good and poor CCs. Prevalences of diabetes mellitus were 27.1% among patients with good CCs and 44% among those with poor CCs (p <0.001). Presence of MS was significantly higher in patients with poor CCs than in those with good CCs (78.4% vs 49.2%, p <0.001). In regression analysis, duration of angina pectoris (β = 0.347, 95% confidence interval [CI] 0.266 to 0.453, p <0.001), presence of diabetes mellitus (β = 1.829, 95% CI 1.021 to 3.279, p = 0.042), wall score (β = 2.379, 95% CI 1.356 to 4.173, p = 0.003), and presence of MS (β = 2.993, 95% CI 1.541 to 5.813, p = 0.001) were independent predictors of angiographically determined poor CCs. In conclusion, MS seems to be independently associated with poor CCs in patients with an occluded right coronary artery.
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OLDER AGE REDUCES COLLATERAL VESSEL DEVELOPMENT IN CARDIAC DISEASE

June 24th, 2001 by Sonia Nichols, senior medical writer -

In older patients with long-standing effort angina, the growth of new vessels that would increase circulation to heart tissues after a heart attack does not occur as well as in younger patients with similar cardiac disease.
In patients with coronary blockage, the body attempts to compensate for the occlusion by generating new branches of vessel growth in areas adjacent to the blockage. Scientists call this process collateral development. Researchers believe patients who experience heart attacks, particularly those who have experienced chest pain or angina during physical effort, are prior beneficiaries of collateral development,...
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It may be that one who is treated for ischemia does not develop collaterals as the treatment may signal compensatory reaction is unnecessry.  It is the gradient pressure of gradual occlusion that would signal myocytes for compensating angiogenesis...a dilated vessel (stent or medication) may not indicates any distress and the system would not call for compensation. It is a proposition I cannot disprove

My collateral bypass of the LAD obviously developed over a long period of time.  I didn't have any chest pain (angina) so there was never any treatment prior to an event of CHF.

[oldie]

I'm avidly looking for arguments to avoid stents and/or bypass. As I read your post it says your husband had 3 CABG and 10 stents and that ALL of them  are occluded. i would be most grateful is you would confirm this. I'm 81, just been diagnosed as having 'suspected' triple occlusions. The cardio has me on medicines for two weeks to see how it goes before we go onto to intervention treatment. which I cannot afford.

[ed34]

A while ago you made a comment regarding me putting hyperlinks into replies. However, it is more efficient than copying and pasting several paragraphs from web pages as you seem to like doing. Could you not simply state "this link is to look at ****" and then we
can decide whether or not we wish to read it?

[kenkeith]

I understand what you are saying, and I suspect we all do the same from time to time. But there appears to be a problem as some of the sentences cut off consistently on your posts that I have read before reaching the right margin in the comment.  I don't think the problem relates to pasting from a hyperlink...just curious...never seen that before, and it doesn't occur with my posting!.

[cblmn7]

you should not put info from the internet or other sources as a opinion. YOU ARE NOT A HEART DR. Some people who are desperate wont know the difference and take your words from the internet as gospel. the only info you should give them is YOUR opinion and experiences and tell them to see their dr. the difference between you and ed34 is he will give his experiences and tell them to see a dr YOU think you are the dr. YOUR NOT!!!!!!!!!!  watch out you may kill someone with your advice. someone may take your internet advice instead of seeing a dr which the should

[kenkeith]

Stop spamming my E-mail.  And your adhominum attacks are unwelcomed here and not in keeping with the general decorum of this forum.  If you have something constructive to add you are welcome otherwise stop  attempting to agitate me...annoying.  I don't have time nor an inkling to answer your e-mails because it doesn't make sense nor does your post.

[cblmn7]

im not spamming you im just telling you to quit play dr. just give advice. if my post made no sense to you then you need serious help