Circulation, Vol 66, 316-320, Copyright © 1982 by American Heart Association
DC Levin and JT Fallon
Postmortem coronary angiographic morphology was correlated with histologic
sections of 73 localized subtotal coronary artery stenoses (50-99%
reduction of luminal diameter) to determine whether complicated or
uncomplicated atherosclerotic lesions could be detected angiographically.
Lesions were divided into two types, according to angiographic morphology:
Type I stenoses had smooth borders, an hourglass configurations, and no
intraluminal lucencies; type II stenoses had irregular borders or
intraluminal lucencies. Histologic sections were also divided into two
types: "uncomplicated" stenoses had fatty or fibrous plaques with intact
intimal surfaces and no superimposed thrombus; "complicated" stenoses
manifested plaque rupture, plaque hemorrhage, superimposed partially
occluding thrombus, or recanalized thrombus. Among 35 lesions with type I
angiographic morphology, four (11.4%) were complicated lesions
histologically. Among the 38 stenoses showing type II angiographic
morphology, 30 (78.9%) were complicated lesions. Postmortem angiography
thus had a sensitivity of 88% and specificity of 79% for detecting
complicated stenoses on the basis of irregular borders or intraluminal
lucencies. Pathologic studies have shown that acute occlusive thrombosis of
a coronary artery is usually associated with complicated atherosclerotic
stenoses. Thus, complicated lesions represent a greater risk factor for
acute myocardial infarction or sudden death than do uncomplicated lesions.
This study suggests that coronary stenoses characterized angiographically
by irregular borders or intraluminal lucencies are probably the clinically
more dangerous "complicated" type.
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