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(Circulation. 2002;106:1308.)
© 2002 American Heart Association, Inc.

Editorial

Clinical Assessment of Atherosclerotic Lesions

Emerging From Angiographic Shadows

John R. Guyton, MD

From Duke University Medical Center, Department of Medicine, Sarah W. Stedman Center for Nutritional Studies, Durham, NC.

Correspondence to John R. Guyton, MD, Duke University Medical Center, Department of Medicine, PO Box 3510, Baker House, Room 281, Trent Dr, Durham, NC 27710. E-mail john.guyton@duke.edu

Key Words: Editorials • atherosclerosis • magnetic resonance imaging • trials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In the mid to late 1800s, the light microscopic features of atherosclerosis were discovered as Virchow and others used techniques that were novel at the time for paraffin embedding, sectioning, and staining of tissues.¹ From then until the past few years, detailed characterization of atherosclerotic lesions has been limited to autopsied or excised tissues, which display only a single time point per specimen. Today, the goal of visualizing and characterizing the diseased arterial wall in living patients has become a reality with the use of several techniques. In this issue of Circulation, Cai and colleagues² demonstrate that magnetic resonance can provide a living "biopsy" of carotid atherosclerotic plaques. Preoperative MRIs correlated well with paraffin section histology of endarterectomy specimens, classified by criteria of the Committee on Vascular Lesions of the Arteriosclerosis Council.³

See p 1368

Because the clinician has such difficulty defining atherosclerosis in living patients, this ubiquitous disease must be managed indirectly. Downstream effects on end-organ ischemia and infarction are measured. An offending plaque may be bypassed or it may be cracked at the edge and displaced by stretching of the underlying tissue. The antecedents to atherosclerosis, termed risk factors, are treated mostly in terms of their relation to end-organ events. Clinical trials have taught us how changing certain risk factors can affect those events. All of this happens with scant knowledge of atherosclerotic lesion progression in the angiographic shadows.

The obscurity of atherosclerosis to the clinician has led to a largely dichotomized approach. If ischemia or infarction . . . [Full Text of this Article]

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