Editorial

Benefits of Percutaneous Coronary Revascularization in Patients with Adequately Collateralized Chronic Total Occlusions

Authors: Jack P. Chen, MD, FACC, FSCAI, FCCP

Abstract

The terms “hibernating” or “stunned” myocardium refer to the continued viability of individual cardiomyocytes, despite a chronic, angiographically totally occluded coronary artery supplying that distribution. Although the subtended myocardial segment appears akinetic or noncontractile, function may return upon restoration of blood supply by mechanical revascularization. The phenomenon is believed to occur due to collateral circulation, or tiny vascular channels, which reroute flow from another vessel. At times, the collateral flow can originate from the same artery just proximal to the occlusion (known as “bridge” collaterals). In these situations, I often tell my patient that the heart has, in effect, grown its own bypass.

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