Circulation, Vol 80, 1603-1609, Copyright © 1989 by American Heart Association
GM Stiel, LS Stiel, J Schofer, K Donath and DG Mathey
To determine whether compensatory enlargement of atherosclerotic coronary
arteries occurs and to what degree it affects the angiographic assessment
of coronary artery disease, we performed postmortem coronary angiography of
30 human hearts with suspected coronary artery disease and studied 70
histologic cross sections of the proximal left anterior descending artery
and proximal right coronary artery. Angiographic and morphometric analyses
of 50 stenoses in proximal and middle sections of the left anterior
descending artery, right coronary artery, and left circumflex artery were
performed. The control group of 10 human hearts without suspected coronary
artery disease was evaluated in the same way. For this purpose, coronary
arteries were filled with a methylmethacrylic radiopaque resin at a
pressure of 100 mm Hg and closely embedded in a methylmethacrylic resin by
use of which shrinkage and mechanical artifacts could be avoided. The area
circumscribed by the internal elastic lamina was taken as a measure of the
area of the arterial lumen if no plaque had been present. The angiographic
and corresponding morphometric degree of stenosis was assessed. A
significant correlation (r = 0.85, p less than or equal to 0.0001) was
found between the internal elastic lamina area and the area of the plaque
(lesion area), suggesting that coronary arteries may enlarge as lesion area
increases. With the morphometric degree of stenosis, the expected anatomic
diminution of the coronary artery was abolished (r = 0.79, p less than or
equal to 0.0001), indicating compensatory enlargement in atherosclerotic
segments. Accordingly, the degree of stenosis assessed from in vitro
angiograms was underestimated. Compensatory coronary enlargement of the
stenotic segment was the main reason for angiographic underestimation. The
underestimation factor of up to 3.50 for very mild stenoses decreased to
1.37 at an angiographic degree of 50% area stenosis and 30% diameter
stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease
Department of Cardiology, University Hospital Eppendorf, Hamburg, FRG.
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