Amount of narrowing by atherosclerotic plaque in 44 nonbypassed and 52 bypassed major epicardial coronary arteries in 32 necropsy patients who died within 1 month of aortocoronary bypass grafting

doi:10.1016/0002-9149(80)90351-3

The American Journal of Cardiology

Volume 46, Issue 6, 1 December 1980, Pages 956-962

https://doi.org/10.1016/0002-9149(80)90351-3 Get rights and content

Abstract

In 32 necropsy patients who died within 30 days of an aortocoronary bypass operation performed for relief of angina pectorls, the lumens in 42 (95 percent) of 44 nonbypassed and in 52 (100 percent) of 52 bypassed arteries were narrowed 76 to 100 percent in cross-sectional area by atherosclerotic plaque. Of 616 five mm segments of the 44 nonbypassed arteries examined histologlcally, 292 (47 percent) were narrowed 76 to 100 percent in cross-sectional area by atherosclerotic plaque; of 728 segments examined in the 52 bypassed arteries, 375 (52 percent) were similarly narrowed. Thirty-two (73 percent) of the 44 nonbypassed coronary arteries (In 23 patients) had been Judged to be narrowed 50 percent or less in diameter on preoperatlve coronary anglography, but at necropsy 31 (97 percent) of these arteries were narrowed 76 to 100 percent in cross-sectional area and the other artery was narrowed 51 to 75 percent. Thus, significant amounts of atherosclerotic plaque tend to be present at necropsy in all three major coronary systems of patients with angina pectorls who die early after an aortocoronary bypass operation.

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Quantitative Extent of Atherosclerotic Plaque in the Major Epicardial Coronary Arteries in Patients with Fatal Coronary Heart Disease, in Coronary Endarterectomy Specimens, in Aorta-Coronary Saphenous Venous Conduits, and Means to Prevent the Plaques: A Review after Studying the Coronary Arteries for 50 Years
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If CAD is so diffuse, as described in earlier portions of this review, is it logical to put conduits in some native arteries and no conduits in others? This question was examined by Waller and Roberts10 who compared the quantity of narrowing in the native coronary arteries that were bypassed versus those not bypassed in patients dying early (<60 days) and later after CABG (Figure 18). The percent of the 5-mm segments narrowed >75% in cross-sectional areas was similar in the bypassed and non-bypassed native coronary arteries whether the patient died early or late (Figure 19).
This review tries to answer the following 15 questions: Is atherosclerosis a systemic or a regional disease? Is atherosclerosis in any particular region focal or diffuse? What is the quantity of atherosclerotic plaques in endarterectomy specimens of the right coronary artery in patients undergoing coronary artery bypass grafting (CABG) compared to that in the right coronary artery in patients with fatal coronary artery disease? How do the units used for measuring arterial narrowing by angiography compare to the units used for measuring arterial narrowing at necropsy? What do atherosclerotic plaques consist of in coronary arteries in patients with fatal coronary disease? What is the quantity of atherosclerotic plaque in bypassed -vs- non-bypassed native coronary arteries in patients dying early (<60 days) or late (>60 days) after coronary artery bypass grafting? What is the frequency of acute coronary lesions and multi-luminal channels at necropsy in patients with unstable angina pectoris, sudden coronary death, and acute myocardial infarction? What is the mechanism of luminal widening by angioplasty in the coronary arteries? What observations suggest that atherosclerotic plaques are the result at least in part of organization of thrombi? Is atherosclerosis a multifactoral or a unifactoral disease? What characteristics distinguish carnivores and herbivores? What are reasonable guidelines for whom to treat with lipid-altering agents? What is the rule of 5 and the rule of 7 in statin therapy? What is the effect of lipid lowering drug therapy on coronary luminal narrowing? What are some requisites for a healthy life?
The Editor's Roundtable: The Vulnerable Plaque
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Assessment of Intermediate Severity Coronary Lesions in the Catheterization Laboratory
2007, Journal of the American College of Cardiology
Citation Excerpt :
A minority of angiographic stenoses might develop by a process of narrowing of the EEM without the presence of a large amount of plaque, a process called negative remodeling (21,22). Similar to a low power histologic cross section, IVUS can identify the presence and extent of plaque and the area of the EEM in vivo, thereby making it more sensitive than angiography (7–12,14,15,17,23). In addition, angiography provides only limited information regarding the composition of the coronary plaque or the degree of calcification (17,24–26).
The management of intermediate coronary lesions, defined by a diameter stenosis of 40% to 70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Intravascular ultrasound (IVUS) and fractional flow reserve index (FFR) provide anatomic and functional information that can be used in the catheterization laboratory to designate patients to the most appropriate therapy. The purpose of this review is to discuss the critical information obtained from IVUS and FFR in guiding treatment of patients with intermediate coronary lesions. In addition, the importance of IVUS and FFR in the management of patients with serial stenosis, bifurcation lesions, left main disease, saphenous vein graft disease, and acute coronary syndrome will be discussed.
Limitations of coronary angiography compared with intravascular ultrasound: Implications for coronary interventions
1999, Progress in Cardiovascular Diseases
The use of intravascular ultrasound catheters to produce images of lumen and plaque cross-sectional areas has had a profound effect on the practice of interventional cardiology. This imaging modality provides, for the first time, a low-power microscopic view of vascular anatomy within a living patient. This article will review some of the advantages of intravascular ultrasound imaging compared with angiography when used for diagnostic or interventional therapeutic procedures. Copyright © 1999 by W.B. Saunders Company
Progress in Cardiovascular Diseases, Vol. 42, No. 2 (September/October), 1999: pp 91-138
Intravascular ultrasound imaging of angiographically normal coronary segments in patients with coronary artery disease
1994, American Heart Journal
Intravascular ultrasound imaging (IVUS) constitutes a new diagnostic technique that provides unique information concerning arterial wall structure and luminal dimensions. To assess the anatomic features of angiographically normal coronary arteries in patients with coronary artery disease, 25 patients (aged 61 ± 9 years) underwent an IVUS examination before coronary angioplasty. A mechanical (20 MHz) IVUS system was used. Atherosclerotic plaques were identified by IVUS as well-defined structures of variable echodensity protruding into the coronary lumen or disrupting normal coronary wall architecture. Five (20%) patients had minor angiographic irregularities proximal to the target lesion, and all 5 had plaque on IVUS. In the remaining 20 patients the coronary segments proximal to the target lesion were angiographically normal. Of these, IVUS demonstrated the presence of plaque in 16 (80%) patients at 19 different angiographic sites (3 lipidic, 13 fibrotic, 3 calcified). Fifteen plaques had a semilunar appearance and did not disrupt luminal contour, but four clearly protruded into the coronary lumen. Six plaques were located in the left main artery, 4 in the left anterior descending artery, 4 in the left circumflex artery, 4 in the right coronary artery, and 1 in a vein graft. On quantitative angiography, luminal diameter, at sites angiographically normal but with plaque on IVUS, was 3.6 ± 1 mm. At these sites, both minimal luminal diameter (3.5 ± 1 mm) and maximal luminal diameter (4.3 ± 1 mm) on IVUS correlated (r = 0.59andr = 0.61, respectively) with angiographic measurements (p < 0.05). No complications resulted from the IVUS study. Thus in patients with coronary artery disease (1) the atherosclerotic involvement of the arterial wall extends beyond the angiographic lesion site; (2) IVUS frequently reveals plaque at sites with a normal angiographic appearance; and (3) these plaques usually have a semillunar shape and do not disrupt luminal contour.
Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography: a follow-up study
1993, International Journal of Cardiology
A follow-up over a 7-year period demonstrated that 8.6% of all patients subjected to coronary arteriography because of angina pectoris had normal coronary arteries (NCA). The somatic and social prognosis of these patients were evaluated and these were compared to that of an age- and sex-matched group of patients with arteriographically verified coronary atherosclerosis (CAD). On average 44 months after coronary arteriography, 2.4% with NCA had died versus 20.5% with CAD (P < 0.001). Myocardial infarction occurred in 0% (NCA) versus 12.8% (CAD) among survivors (P < 0.001). Coronary revascularization was carried out in 0% (NCA) versus 76.9% (CAD). Chest pain was unchanged or had worsened in 58.2% (NCA) versus 21.1% (CAD) (P < 0.001) and this in the NCA patients was correlated to the occurrence of minimal lesions of the coronary arteries. Of the NCA patients, 33.3% had ischaemia during exercise-ECG. Normalization was seen in 12 patients and newly developed ischaemia in seven patients. Three patients developed ischaemia during hyperventilation test. Eighty percent (NCA) versus 63.9% (CAD) gave up work due to chest pain (P < 0.001). Further, 55.7% (NCA) versus 34.6% (CAD) had reduced daily activities (P < 0.001); similarly, the frequency of divorce was higher in the NCA group (10.2%) than in the CAD group (1.3%) (P < 0.05).

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Clinical studyAmount of narrowing by atherosclerotic plaque in 44 nonbypassed and 52 bypassed major epicardial coronary arteries in 32 necropsy patients who died within 1 month of aortocoronary bypass grafting

Abstract

Am J Med

Am J Cardiol

Prog Cardiovasc Dis

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Comparison of degrees of coronary arterial luminal narrowing determined by visual inspection of histologie sections under magnification among independent observers and comparison to that obtained by vide-oplanimetry: an analysis of 559 five-mm segments of 61 coronary arteries from eleven patients

Lab Invest

Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings

Ann Intern Med

Quantification of coronary arterial narrowing in clinically-isolated unstable angina pectoris. An analysis of 22 necropsy patients

Am J Med

Quantnation of coronary arterial narrowing at necropsy in acute transmural myocardial infarction: analysis and comparison of findings in 27 patients and 22 control

Circulation

Clinical study
Amount of narrowing by atherosclerotic plaque in 44 nonbypassed and 52 bypassed major epicardial coronary arteries in 32 necropsy patients who died within 1 month of aortocoronary bypass grafting