Collateral Flow Reversal: Exploring Protective Role of Collateral Circulation in Acute Coronary Syndrome
Bhatnagar, U.B.; Nelson, G.; Stys, A.
South Dakota Medicine the Journal of the South Dakota State Medical Association 72(4): 174-177
2019
ISSN/ISBN: 0038-3317 PMID: 31436931 Document Number: 698933
The effect of pre-existing collateral circulation on presentation of acute coronary syndrome (ACS) is not well known. We present a case of a 54-year-old male with a known history of chronic total occlusion of left circumflex artery and well-developed collaterals, who presented to the emergency department with non-STsegment elevation myocardial infarction. He underwent urgent coronary angiogram which showed an acute total thrombotic occlusion in proximal large right coronary artery with collaterals from left to right. After percutaneous coronary intervention, the collaterals reversed to a right to left direction. We postulate that the well-developed collateral circulation protected the patient from larger transmural ischemia and ST elevation myocardial infarction.