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Inner layer infarction of the coronary artery wall due to coronary thrombosis
1Department of Pathology, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany. waldemar.hort@uni-duesseldorf.de
Insights
Inner layers of coronary artery walls adjacent to thrombi often infarct. Thinner intima correlated with fewer infarctions, suggesting vasa vasorum supply is key to understanding plaque necrosis.
Area of Science:
- Cardiovascular Pathology
- Vascular Biology
- Histopathology
Background:
- Coronary artery thrombosis is a major cause of myocardial infarction.
- The pathogenesis of necrosis within atherosclerotic plaques remains incompletely understood.
- The role of vasa vasorum in supplying nutrients to the inner layers of coronary arteries requires further investigation.
Purpose of the Study:
- To investigate the extent and characteristics of inner layer infarctions in coronary artery segments with thrombosis.
- To determine the relationship between intima thickness and inner layer necrosis.
- To elucidate the role of vasa vasorum in the preservation of the media layer.
Main Methods:
- Postmortem coronary angiography was performed on 112 coronary artery segments from 65 human hearts.
- Histological examination of 19 specimens from hearts with thrombosed segments but without atherosclerotic lesions.
- Quantitative analysis of intima thickness and inner layer necrosis diameter.
Main Results:
- Inner layers of coronary artery walls adjacent to thrombi were frequently infarcted.
- Segments with the thinnest intima showed a lack of inner layer infarctions.
- Noninfarcted wall tissue (mean thickness 190+/-28 micro m) was supplied by vasa vasorum in the adventitia, approximately 40 micro m from the media.
Conclusions:
- Inner layer necrosis in coronary arteries is associated with thrombosis and influenced by intima thickness.
- The vasa vasorum network in the adventitia appears crucial for supplying the outer wall layers.
- Understanding vasa vasorum supply may offer insights into the pathogenesis of atherosclerotic plaque necrosis.
Abstract:
Cross sections of 112 coronary artery segments from 65 human hearts with coronary thromboses were investigated after postmortem coronary angiography. In almost all cases the inner layers of coronary artery walls adjacent to the obstructing thrombi or to parietal thrombi were infarcted. These infarctions followed nearly the same course as classical infarctions. From 13 hearts with segments occluded by thrombi but without atherosclerotic lesions, 19 specimens were found suitable for quantitative investigations. The 2 segments with the thinnest intima were lacking in inner layer infarctions. The other 17 specimens contained areas of inner layer necrosis of increasing diameter, depending on the thickness of the wall. In each case the media was completely preserved. The mean thickness of the noninfarcted wall tissue was 190+/-28 micro m. This noninfarcted wall tissue was supplied by vasa vasorum in the adventitia located at an average distance of approximately 40 micro m from the media. The knowledge of the supplying areas of the vasa vasorum could help us understand the pathogenesis of necroses in atherosclerotic plaques.