Why the effects of treatment with EECP may be sustained?

It is postulated that the repeated and pulsed increases in diastolic pressure during therapy with EECP may enhance or stimulate the opening of collateral channels in the coronary vascular system, increasing perfusion of ischemic areas.While the exact stimuli and mechanisms for the development of coronary collaterals in humans is unknown, a report of an animal study has shown that when diastolic pressures were raised above systolic pressures, sequential external counter pulsation was effective in increasing myocardial perfusion and promoted the formation of collateral circulation.Some of these patients have had initial and sustained (3-year) improvement in myocardial perfusion of ischemic areas as demonstrated through thallium-201 imaging, and suggest that these patients may have responded to therapy with EECP through enhanced coronary collateral development or function.