To define the specific pathways of coronary collateral circulation, the rec ords of 250 consecutive patients who had significant coronary artery disease as documented with arteriograms were systematically reviewed. All of them were free from valvular disease, and none had had coronary bypass graft when eval uated. Coronary stenosis involved mostly the left anterior descending artery (LAD), then the right coronary artery (RCA), and finally the left circumflex artery (LCX). Coronary collateral circulation was seen only in the artery with more than 90% stenosis; the frequency of collateral circulation was 73.7% in the RCA, 36.6% in the LAD, and 26% in the LCX. Eleven different pathways were noted in patients having stenosis of the RCA; ten different pathways, in patients having stenosis of the LAD; and six different pathways, in patients having stenosis of the LCX. The related clinical significance is discussed.
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