Preferential dilation of recipient coronary arteries of the collateral circulation by intracoronary administration of nitroglycerin

Objectives. The purpose of this study was to test the hypothesis that the sensitivity to nitroglycerin of collateral vessels and recipient arteries is greater than that of donor arteries of the collateral circulation. Background. The collateral circulation responds vigorously to nitroglycerin. However, the mechanisms of the efficacy of nitroglycerin for improving collateral circulation are not fully elucidated. Methods. The diameter of donor and recipient arteries of the collateral circulation was measured with a computer-assisted analysis system in eight patients with well developed collateral vessels. Coronary angiography was repeated before and after the intracoronary injection of 50 μg of nitroglycerin. Results. After nitroglycerin, the mean diameter ± SD of donor arteries increased to 1.61 ± 0.53 from 1.29 ± 0.39 mm (p < 0.01), whereas the diameter of recipient arteries increased to 1.59 ± 0.50 from 1.10 ± 0.49 mm (p < 0.01). The change in the diameter of recipient arteries was significantly greater than that of donor arteries (52.3 ± 24.6% vs. 24.7 ± 11.5%, p < 0.05). These changes induced by the intracoronary injection of nitroglycerin were accompanied by a decrease in pacing-induced ST segment depression (0.16 ± 0.06 to 0.06 ± 0.04 mV, p < 0.01), suggesting increased flow reserve through collateral channels. Conclusions. These findings indicate that the sensitivity to nitroglycerin of recipient arteries of the collateral circulation is significantly greater than that of donor arteries. This observation may explain the strong response of the collateral circulation to nitroglycerin in patients with functionally significant collateral channels.