Are routine autopsy protocols adequate for accurate appraisal of coronary atherosclerosis?

Atherosclerotic involvement of 1,106 coronary arterial trees was investigated by means of gross inspection, light microscopy, and the method of successive observations of similar topographic sites placed in sequence according to age, sex, cause of death, and anatomic branching pattern. The results obtained, based on strict adherence to routine autopsy protocols, were compared with control studies, which demonstrated that such strict adherence had constrained us to overlook the following aspects: a) existence of particular anatomic branching patterns, such as those of atherogenic character and/or involved in onset of myocardial ischemia; b) development of obstructive plaques in coronary branch vessels; c) presence of obstructive lesions in vessels which supply the conduction system; d) the obstructive character of platelet and fibrin microemboli and thrombi which showered the intramyocardial vessels; e) accurate identification, classification, and grading of atherosclerotic lesions with the aid of routine autopsy protocols, which was not possible in our material.