Circulation, Vol 57, 1103-1110, Copyright © 1978 by American Heart Association
LC Becker
The conditions for coronary steal were determined using the two
vasodilators--dipyridamole and nitroglycerin--in anesthetized dogs after
ligation of the left anterior descending coronary artery (LAD). Previous
studies have shown that when the non-ligated coronary arteries are normal,
collateral flow increases after dipyridamole. This study utilized a model
in which the distal LAD was ligated and the proximal LAD and left
circumflex (LC) arteries were stenosed. Heart rate and blood pressure were
kept constant. In 20 dogs, 1-1.5 mg/kg dipyridamole caused a decrease in
flow to the ischemic region as measured by radioactive microspheres (0.19
to 0.14 ml/min/g, P = 0.05) while flow increased four-fold to surrounding
nonischemic myocardium. The decrease in collateral flow was confined to the
epicardial half of the ischemic region (0.26 to 0.14 ml/min/g, P less than
0.001) and was associated with an increase in sigmaST from 30.9 to 44.7 mV
(P less than 0.01). In five dogs nitroglycerin, 5 microgram/kg/min,
produced no significant changes in collateral flow or flow to other parts
of the LV, and sigmaST was unchanged. Vasodilator-induced coronary steal
therefore appears to require 1) an arteriolar-type dilator like
dipyridamole and 2) stenoses of the arteries supplying collateral flow to
the ischemic region. The steal phenomenon is probably caused by a decrease
in pressure distal to the stenoses in these vessels, resulting in reduced
driving pressure for collateral flow.
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Conditions for vasodilator-induced coronary steal in experimental myocardial ischemia
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