Bypassing bypass surgery by growing new arteries

18 Aug

by Carolyn Thomas  @HeartSisters

The human body is endlessly fascinating, isn’t it? Consider how humans get started in the first place – only after one tiny sperm, one of hundreds of millions, has somehow negotiated its way past the lethal acid coating the vagina and made its long journey up to the waiting egg.  The odds are stupefyingly against that one brave little sperm. 

And then, consider the heart.

Before my heart attack, I had never heard of the heart’s little collateral arteries. These are small, normally closed arteries that, in times of dire need (like a blocked coronary artery that leads to a heart attack) can wake up, open wide, and enlarge enough to form a kind of detour around the blockage, thus providing an alternate route of blood supply to feed the oxygen-starved heart muscle. Do-it-yourself bypass surgery!

Consider also the example of Juliet’s life-saving collateral arteries. At the age of 46, this young mother of two in London, England suffered a heart attack due to Spontaneous Coronary Artery Dissection (SCAD).

Like most SCAD patients, she had no cardiac risk factors, and was very healthy at the time. (Just the day before, she had gone on a 40-minute run). But her early heart attack symptoms were initially misdiagnosed, and she now suspects that the tear in her artery may have unravelled further by the time she underwent a diagnostic angiogram. Juliet ended up with five stainless steel stents implanted along the length of her torn Left Anterior Descending (LAD) coronary artery.

But then things went from bad to worse for Juliet, as over the next three months, her stents re-stenosed (blocked) due to scar tissue build-up. She explains:

“During the period of re-stenosis and for about a year after, I suffered angina pain on exertion and most particularly after eating. Unfortunately, the stents subsequently failed, and my LAD is now 100% occluded with scar tissue. But that part of my heart is now functioning on collateral circulation. The chest pain symptoms disappeared slowly as my collateral arteries developed.

“It was a happy surprise to discover how wonderfully a heart can adapt with collaterals, and although I would love to still have the use of my LAD, I am doing fine without it!

“My cardiologists said these collateral arteries would have started to develop as soon as my LAD started to re-stenose, especially as I went straight back to running, post-cardiac rehab. I am surprisingly well and happy to be alive.”

Some researchers suggest that, because Juliet was already a physically active runner, her own collateral arteries may have already started this important process called arteriogenesis, which is defined as the transformation of pre-existing collateral artery pathways into conducting vessels.

In 2004, Swiss researchers*, for example, found that enhanced physical exertion (like running) may indeed cause those tiny collaterals to kick into action.  Study authors explained in the journal, Heart:

“For the first time in a human being with entirely normal coronary arteries, we have shown evidence of enhanced coronary collateral flow in response to an endurance exercise programme.”

I’ve been told the same theory – that my 19 years of distance running contributed to that enhanced coronary collateral flow, which may have been the factor that helped to save me during my own heart attack, despite having a Left Anterior Descending coronary artery that was also fully occluded.

While every human has these amazing little sleeping arteries, not every collateral will work when it needs to – especially if you’re not training for a marathon.

Researchers at Tel Aviv University have recently developed a protein-based injection that, delivered straight to muscles in the body, may spark the regrowth of tiny new blood vessels, much like the body’s own collateral arteries.

Researchers had initially started their study hoping to discover a way to prevent leg amputations, but their preliminary tests have shown potential value to future heart patients whose arteries are so occluded that bypass surgery is needed.

Currently, as in Juliet’s case, implanting a stainless steel stent into a coronary artery is accompanied by a risk of future blood clots within or near the stent itself, which necessitates the prolonged use of blood-thinning anti-platelet meds.

When I had a stainless steel stent implanted after my own heart attack, I was prescribed a what’s known as duel anti-platelet therapy: a drug called Plavix (clopidogrel, a powerful and expensive  anti-platelet drug) plus low-dose aspirin every day.

Find out more about this emerging research, or about collateral arteries, or about Spontaneous Coronary Artery Dissection (SCAD).

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* R Zbinden, S Zbinden, S Windecker, B Meier, and C Seiler, “Direct demonstration of coronary collateral growth by physical endurance exercise in a healthy marathon runner”. Heart. 2004 November; 90(11): 1350–1351.

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12 Responses to “Bypassing bypass surgery by growing new arteries”

  1. Susan Masin April 23, 2013 at 8:08 pm #

    I just completed 40 EECP treatments (Enhanced External Counterpulsation therapy). I had debilitating angina and was unable to exercise. After these treatments, I can now power walk/run up to one hour with no chest discomfort. I have also been taken off three of my five antihypertensive medications from my BP decreasing dramatically from the treatments. I am a believer in EECP!!!

    Like

    • Carolyn Thomas April 23, 2013 at 8:35 pm #

      That’s fantastic news, Susan! For readers wanting more info on EECP, read this. Or see Sharon’s EECP story – and cool photos – here.

      Like

    • Lina July 31, 2013 at 5:15 pm #

      Susan, where did you go for the EECP treatment?
      I live in Vancouver B.C.
      Thank you indeed
      Lina

      Like

      • Carolyn Thomas July 31, 2013 at 6:08 pm #

        Lina, Dr. Rod Santos offers this treatment in his Burnaby clinic. You could call his office for more info.

        Like

        • Lina August 3, 2013 at 8:21 am #

          Thank you.
          But he’s not performing EECP any longer.
          Anybody else?
          Yours
          Lina

          Like

          • Carolyn Thomas August 3, 2013 at 8:23 am #

            He’s not?! His website still features EECP services – maybe contact him for more info?

            Like

            • Lina August 3, 2013 at 9:44 am #

              I did contact him.
              The answer is – NO, he doesn’t do it anymore
              Thanks again
              Lina

              Like

  2. rehabilitateyourheart April 1, 2013 at 5:23 am #

    Another way of growing collateral arteries for people who have too much angina to be able to physically exercise is go through EECP therapy, a non invasive use of cuffs on the legs and buttocks which synchronously squeeze/push the blood back into the heart during its relaxation phase, thus providing more blood to the heart wall and helps to open the small collateral arteries. You can see the improvement on subsequent catheterizations. Many patients get enough relief of angina that they can return to exercise.

    Like

  3. RRastani November 7, 2011 at 3:36 am #

    What a truly magical concept this is. Like white blood cells and platelets springing into action when a finger is cut, our bodies are indeed miraculous self-healing machines. Trouble is, not every patient will be as lucky as your U.K. example here, particularly if they are not physically active. This is a compelling reason for increasing our physical fitness – the more we can strengthen our muscles and thus help to build up those ‘collaterals’, the better.

    Like

  4. Ami Woo March 15, 2011 at 7:26 am #

    My cardiologist told me that this is likely what has happened to me, my blockage did not require treatment because of these collaterals. Thank you for helping to inform people of amazing phenomenon.

    Like

  5. Mika January 12, 2010 at 6:09 am #

    Fascinating.

    The human body is endlessly mysterious, isn’t it?

    Thank you for this interesting information, and also for being such a valuable resource for women’s heart health. I have subscribed to receive all of your future updates.

    Thanks again.
    Mika in Tokyo

    Like

    • Daniel Jones February 1, 2014 at 8:28 pm #

      My heart grew its own bypass as well…I still smoke and am not physically active just very fortunate indeed.
      very sincerely Daniel Jones

      Like

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