Document Detail

Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary artery disease.
MedLine Citation:
PMID:  2598424     Owner:  NLM     Status:  MEDLINE    
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)
G M Stiel; L S Stiel; J Schofer; K Donath; D G Mathey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  80     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1989 Dec 
Date Detail:
Created Date:  1990-02-01     Completed Date:  1990-02-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1603-9     Citation Subset:  AIM; IM    
Department of Cardiology, University Hospital Eppendorf, Hamburg, FRG.
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MeSH Terms
Aged, 80 and over
Angiography / standards
Constriction, Pathologic / pathology
Coronary Artery Disease / pathology,  radiography*
Coronary Vessels / pathology*
Middle Aged

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