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Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study Contemporary techniques in percutaneous coronary intervention for bifurcation lesions Treatment of Very Small De Novo Coronary Artery Disease With 2.0 mm Drug-Coated Balloons Showed 1-Year Clinical Outcome Comparable With 2.0 mm Drug-Eluting Stents Influence of Local Myocardial Damage on Index of Microcirculatory Resistance and Fractional Flow Reserve in Target and Nontarget Vascular Territories in a Porcine Microvascular Injury Model Adaptive development of concomitant secondary mitral and tricuspid regurgitation after transcatheter aortic valve replacement Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial Optical Coherence Tomography–Defined Plaque Vulnerability in Relation to Functional Stenosis Severity and Microvascular Dysfunction Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group Clinical and angiographic outcomes of coronary dissection after paclitaxel-coated balloon angioplasty for small vessel coronary artery disease Drug-Coated Balloons: A Safe and Effective Alternative to Drug-Eluting Stents in Small Vessel Coronary Artery Disease
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Review Article2018 Jun 25.[Epub ahead of print]

JOURNAL：Curr Pharm Des. Article Link

Coronary Microcirculation in Ischemic Heart Disease

Pries AR, Kuebler WM, Habazettl H. Keywords: Angioadaptation; Heterogeneity; Inflammation; Leucocyte-Endothelium Interaction; Microvessels; vascular Permeability

ABSTRACT

BACKGROUND - Ischemic heart disease has long been considered to be exlusively caused by stenosis or occlusion. However, the coronary microcirculation too may play an important role in ischemic conditions. Also, the crucial role of microvessels in not only regulating blood flow on a local level but also mediating vascular permeability or inflammatory responses has been recognized.


OBJECTIVE - To review important physiological and pathophysiological mechanisms of coronary microcirculatory control with focus on heterogeneity of local perfusion, microvascular permeability and inflammation.

METHOD - Selective research of the literature.

RESULTS - Heterogeneity is a characteristic of microvascular networks and affects structural and functional parameters such as vessel diameter, length, and connection pattern, flow velocity, wall shear stress, and oxygenation. The networks are optimized to meet the metabolic demand of all tissue compartments. This requires continuous vascular adaptation regulated by local hemodynamic and metabolic stimuli. Compromising this regulation results in functional arterio-venous shunting and tissue areas with either hyperperfusion or hypoxia in close proximity. In ischemia-reperfusion, increased microvascular permeability may aggravate tissue hypoxia by increasing extravascular pressure and seems to contribute to adverse myocardial remodeling. Transendothelial transport mechanisms and deterioration of the endothelial glycocalyx seem to be major contributors to tissue edema. Also in the context of ischemia-reperfusion, an inflammatory response mediated by venular endothelium expressing specific adhesion molecules contributes to tissue injury. However, anti-inflammatory therapies failed in clinical studies and a multi-targeted approach for cardiac protection has been demanded.

CONCLUSION - Disturbances of the coronary microcirculation are involved in different pathophysiological aspects of reperfusion injury.

Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.
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