Coronary arterial stenosis. An autopsy study

Area of Science:

• Cardiovascular Pathology
• Forensic Medicine
• Histopathology

Background:

• Coronary artery disease (CAD) is a leading cause of mortality worldwide.
• Understanding the prevalence and characteristics of coronary artery stenosis is crucial for public health.
• Medico-legal autopsies provide a valuable resource for studying cardiovascular conditions in diverse populations.

Purpose of the Study:

• To investigate the prevalence, types, and severity of coronary artery narrowing in a local population.
• To compare the characteristics of coronary artery lesions with findings from Western populations.
• To determine the optimal methodology for assessing coronary artery stenosis.

Main Methods:

• Analysis of 131 medico-legal autopsies across a wide age range (5-80 years).
• Coronary angiography following radio-opaque dye injection to assess narrowing.
• Macroscopic and microscopic examination of coronary arteries, including transverse sectioning at 3 mm intervals.
• Classification of lesions into concentric (diffuse intimal thickening, fibrous plaques, calcifications, thrombosis) and eccentric types.

Main Results:

• Eccentric lesions accounted for 60% of occlusions, while concentric lesions (including diffuse intimal thickening) comprised 40%.
• The left anterior descending artery (LAD) showed the highest incidence and severity of narrowing, followed by the left circumflex and right coronary artery (RCA).
• Proximal segments of coronary arteries were most affected; lesions in this population appear to lag 2-3 decades behind Western populations.

Conclusions:

• Diffuse intimal thickening (DIT) due to lipid accumulation contributes to minimal narrowing in a significant portion of the local population.
• Eccentric lesions are the predominant cause of severe coronary artery narrowing.
• Microscopic examination, followed by radiological and gross assessment, is the most effective method for studying occlusive coronary lesions.