Coronary collateral circulation is the most poorly understood, and often neglected concept among the cardiology community.There is a general perception , in obstructive CAD , coronary collaterals are an inferior modality of back up blood supply than artificial collateral (Also called CABG ) ! One of the reasons, it is been ridiculed by many mainstream cardiologists is because , it comes by nature , and also free of cost !
The often quoted statement* ,collateral blood flow can not sustain blood flow during exercise , is not based on solid scientific data. In the real world , there are thousands of patients actively pursuing life with chronic total occlusion and good collaterals.
It is surprising , there is no physiologically valid , controlled study available to compare CABG with natural collaterals
*When repeatedly told , a statement becomes a fact !
It can be assumed (Unscientifically ofcourse ! ) the remarkable success of medical therapy in COURAGE and the OAT * study can be attributable to the naturally occurring coronary collateral circulation.
* Summary of COURAGE & OAT : A block in the coronary artery need not be opened to prolong human survival !
You draw your own conclusions from the following case study
A 40 year old women , with stable angina and good physical activity
Her angiogram shows.
RCA injection
Dr.S.Venkatesan MD 
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