What is coronary steal and what agents might induce it?

What is coronary steal and what agents might induce it?

Coronary steal may occur when a segment of the myocardium distal to a stenotic coronary artery receives its major blood supply from collateral vessels that originate from a “normal” segment of myocardium supplied by a normal coronary artery. Arteriolar vasodilators (e.g., isoflu-rane, sodium nitroprusside, and dipyridamole) may decrease the flow across the collateral vessels by dilating the arterioles in the normal segment of myocardium. However, there is no convincing evidence that isoflurane should be avoided in patients with CAD provided that excessive tachycardia and hypotension do not occur. It would be prudent, though, to avoid arteriolar vasodilators in patients with “steal-prone” anatomy.