Eid-Lidt G

Idioma: Español
Referencias bibliográficas: 28
Paginas: 50-55
Archivo PDF: 85.99 Kb.

RESUMEN

La circulación colateral (CC) coronaria son conexiones anastomóticas en ausencia de lecho capilar entre dos segmentos de la misma arteria o entre dos arterias coronarias diferentes. Los determinantes del desarrollo de la CC son la duración de la angina previa al infarto, la severidad de la lesión coronaria, el gradiente de presión y el incremento en el estrés de la pared vascular. En presencia de un gradiente hemodinámico significativo el incremento secundario en el flujo sanguíneo y el efecto mecánico a nivel de las arteriolas pre-existentes activa al endotelio con los subsecuentes cambios morfológicos, de remodelación vascular y producción de factores de crecimiento relacionados con la angiogénesis y arteriogénesis. Podemos encontrar CC bien desarrollada por angiografía en el 25 a 37% de los pacientes univasculares y hasta en el 74.7% de pacientes trivasculares. La CC coronaria puede ser evaluada en forma cualitativa por medio de la angiografía coronaria y cuantitativa empleando valores derivados de presión y Doppler intracoronario. La demostración de CC suficiente se asocia con menor formación de aneurisma ventricular y tamaño del infarto, reducción en los eventos isquémicos adversos, mejoría en la función ventricular y en la sobrevida hospitalaria y a largo plazo.

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