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[Quantitative morphologic studies of so-called dynamic, eccentric coronary stenoses in cases of acute coronary death]
1Instiut für Rechtsmedizin am Universitätsklinikum Essen-GHS, Bundesrepublik Deutschland.
Insights
Eccentric coronary artery stenosis, characterized by a larger normal wall segment, can cause dynamic lumen reduction, leading to myocardial ischemia and sudden cardiac death. This study quanties the prevalence and significance of eccentric stenoses in fatal coronary events.
Area of Science:
- Cardiovascular Pathology
- Interventional Cardiology
- Forensic Pathology
Context:
- Eccentric coronary artery stenosis can cause lumen reduction via medial spastic contraction.
- These dynamic stenoses are linked to myocardial ischemia and sudden cardiac death (SCD).
- Understanding stenosis morphology is crucial for assessing acute coronary events.
Purpose:
- To quantitatively analyze the prevalence and characteristics of eccentric coronary artery stenoses in cases of sudden coronary death.
- To evaluate the functional significance of the residual normal wall segment in eccentric stenoses.
- To emphasize the importance of considering stenosis type in morphological evaluations of coronary sclerosis.
Summary:
- Postmortem coronary angiography and planimetry were used to examine 382 stenoses (>45% narrowing) in 39 SCD cases.
- Nearly half (48.6%) of stenoses were eccentric, frequently located in the Right Internal Vertebral Artery (RIVA).
- Eccentric stenoses, with an average of 4.5 per case, showed a significant residual lumen reduction (30.5%) due to the normal wall segment.
Impact:
- Findings highlight the functional significance of eccentric stenoses in acute coronary deficiency.
- Suggests that the proportion of normal wall in eccentric stenoses impacts lumen dynamics.
- Recommends incorporating stenosis morphology, specifically eccentricity, into routine evaluations of coronary atherosclerosis.
Abstract:
The residual normal wall segment of an eccentric stenosis of the coronary artery can reduce the residual lumen by spastic contraction of the media. Such dynamic coronary artery stenoses may consequently cause or intensify myocardial ischemia or may lead to sudden coronary death due to dysrhythmia. In 39 cases of sudden coronary death, the histological cross section of extramural coronary arteries were measured by planimetry after postmortem coronary angiography. Of a total of 382 stenoses wit more than 45% narrowing, 178 (48.6%) were of the eccentric kind. These eccentric stenoses of the coronary artery were localized in the RIVA in 48%. On average, 4.5 eccentric stenoses were found in each case of coronary death. Eccentric stenoses with round (49.4) or elliptically situated (35,3%) restenoses was on average 30.5% of the residual lumen wall. The quantitative findings show that the high percentage of eccentric stenoses with a larger normal wall segment is of functional significance with regard to acute coronary deficiency. The morphological description and evaluation of the coronary sclerosis should also take into consideration the kind of stenosis.