Abstract
Most coronary thrombi large enough to be detected by angiography are associated with tears or fissures in the caps of atherosclerotic plaques. These fissures allow blood to penetrate into the arterial wall, whereupon thrombus forms within the intima; this may be followed by thrombosis in the lumen. This process was first described in 1926 (Benson, 1926; Constantinides, 1966); however, its pre-eminence in initiating acute clinical events was realized more recently after the microanatomy of coronary thrombi was established by serial histological sectioning (Fulton,1965; Davies and Thomas, 1981, 1985). Knowledge of post-mortem angiographic appearance of plaque fissures allowed them to be recognized in the angiograms of living patients with unstable angina (Ambrose, 1985, 1988; Lo et al., 1988) or with acute myocardial infarction, (Ambrose et al., 1985, 1986) and in patients resuscitated from sudden ischemic death. Angioscopy in living patients with unstable angina has also confirmed the presence of mural thrombi on torn atherosclerotic plaques in the coronary arteries (Sherman et al., 1986; Forrester et al., 1987).
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Ambrose JA, Winters SL, Arora RR. (1986). Angiographic evolution of coronary artery morphology in unstable angina. J Am Coll Cardiol; 7: 472–478
Ambrose JA, Winters SL, Stern A, et al. (1985). Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol; 5: 609–616
Ambrose JA, Winters SL, Arora RR. (1985) Coronary angiograph morphology in acute myocardial infarction: link between the pathogenesis of unstable angina and myocardial infarction. J Am Coll Cardiol; 6: 1233–1238
Ambrose JA, Tannenbaum MA, Alexopoulos DA, et al. (1988). Angiographic progression of coronary artery disease and the develop ment of myocardial infarction. J Am Coll Cardiol; 12: 56–62
Benson RL. (1926). The present status of coronary arterial disease. Arch Pathol; 2: 870–916
Constantinides P. (1966). Plaque fissuring in human coronary thrombosis. J Atheroscl Res; 6: 1–17
Davies MJ, Thomas AC. (1981). The pathological basis and microanatomy of occlusive thrombus formation in human coronary arteries. Phil Trans R Soc Lon B; 294: 225–229
Davies MJ, Thomas AC. (1985). Plaque fissuring-the cause of acute myocardial infarction, sudden ischaemic death and crescendo angina. Br Heart J; 53: 363–373
Forrester JS, Litvack, Grundfest W, Hickey A. (1987). A perspective of coronary disease seen through the arteries if a living man. Circulation; 75: 505–513
Fulton WFM. (1965). The coronary arteries: arterography microanatomy and pathogenesis of obliterative coronary disease. Spring field, illinois: Charles C. Thomas, 230–296
ISIS-2 Second International Study of Infarct Survival Collaborative Group (Lancet 1988 ). Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS 2. ii: 349–60
Keeney SM, Richardsonb PD. (1987). Stress analysis of atherosclerotic arteries. Proceedings of the Ninth Annual Conference, Engineering in Medicine and Biology Soc. Inst Elec Electronic Engrs; 3: 1484–1485
Levin DC, Fallon JT. (1982). Significance of the angiographic morphology of localized coronary stenosis:histopathologic correlations. Circulation; 66: 316–320
Lewis, H.D. Jr., Davis, J.W., Archibald, D.G. et al. (1983). Protective effects of Aspirin against acute myocardial infarction and death in men with unstable angina. New Engl. J. Med. 309: 396-403
Lo Y-S-A, Cutler JR, Blake K, Wright Am, Kron J, Swerdlow CD. (1988). Angiographic coronary morphology in survivors of cardiac arrest. Am Heart J; 115: 781–785
Meade, T.W. (1990). Low-dose warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease. Amer. J. Cardiol., 65, 7c-11c
Mitchinson MJ, Ball RY. (Lancet 1987 ). Macrophages and atherogenesis. ii: 146–148
Peto, R, Gray, R., Collins R., et al. (1988). A randomized trial of the effects of prophylactic aspirin among male British doctors. Br. Med. J. 196: 313-316
Richardson, P.D., Davies, M.J. and Born, G.V.R. (Lancet 1989 ). The role of plaque configuration and stress distribution in the pathogenesis of fissuring in human coronary atherosclerotic plaque. ii: 941–944
Sherman CT, Litvack F, Grundfest W, et al. (1986). Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med; 315: 913–919
Steering Committee of Physicians Health Study Research Group (1988). Preliminary report: findings from the aspirin component of the ongoing physicians health study. New Engl. J. Med. 318: 262–4
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1990 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Born, G.V.R. (1990). Causation and Prevention of Coronary Thrombosis : Present Situation. In: Harenberg, J., Heene, D.L., Stehle, G., Schettler, G. (eds) New Trends in Haemostasis. Veröffentlichungen aus der Geomedizinischen Forschungsstelle der Heidelberger Akademie der Wissenschaften, vol 1990 / 1990/3. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84318-1_23
Download citation
DOI: https://doi.org/10.1007/978-3-642-84318-1_23
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-53275-0
Online ISBN: 978-3-642-84318-1
eBook Packages: Springer Book Archive