Correlation of Postmortem Angiography with Pathologic Anatomy

Quantitation of Atherosclerotic Lesions
  • Christopher K. Zarins
  • Michael A. Zatina
  • Seymour Glagov
  • M. Gene Bond


Angiography is a useful and specific clinical means for identifying and assessing atherosclerotic lesions. However, since it provides images only of the arterial lumen, quantitative assessment of the extent and complexity of atherosclerotic disease can only be surmised indirectly. Accurate evaluation of lumen contour by angiography in vivo is complicated by vessel motion, angulation, branching, and overlapping as well as by variations in x-ray technique, magnification, projection, and dye concentration. Inconsistencies in imaging are compounded by observer variability in interpretation of angiographic images (1), making quantitative angiographic assessment of disease difficult. In an effort to gauge the accuracy of angiography, a number of investigators have compared the degree of lumen stenosis as seen on angiography in vivo to the degree of stenosis as seen at postmortem examination, and have come to the conclusion that angiography in vivo underestimates stenoses (2–6). This discrepancy is thought to occur because plaques cause arterial lumens to be “eccentric and slit-like” (2,6) rather than rounded, so that many angiographic projections may show deceptively wide lumens. In most validation studies, excised arteries were fixed by simple immersion without restoration of in vivo vessel configuration.


Lumen Diameter Intraluminal Pressure Internal Elastic Lamina Arterial Lumen Perfusion Fixation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Slot HB, Strijbosch L, Greep JM (1981) Interobserver variability in single-plane aortography. Surgery 90: 497–503PubMedGoogle Scholar
  2. 2.
    Isner JM, Kishel J, Kent KM, Ronan JA Jr, Ross MA, Roberts WC (1981) Accuracy of angiographic determination of left main coronary arterial narrowing. Circulation 63: 1056–1064PubMedCrossRefGoogle Scholar
  3. 3.
    Vlodaver Z, Frech R, Van Tassel RA, Edwards JE (1972) Correlation of the antemortem coronary arteriogram and the postmortem specimen. Circulation 47: 162–169Google Scholar
  4. 4.
    Grondin CM, Dyrda I, Pasternac A, Campeau L, Bourassa MG, Lesperance J (1974) Discrepancies between cineangiographic and postmortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 49: 703–708PubMedGoogle Scholar
  5. 5.
    Arnett EN, Isner JM, Redwood DR, Kent KM, Baker WP, Ackerstein H, Roberts WC (1979) Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 91: 350–356PubMedGoogle Scholar
  6. 6.
    Vlodaver Z, Edwards JE (1971) Pathology of coronary atherosclerosis. Prog Cardiovasc Dis 14: 256–274PubMedCrossRefGoogle Scholar
  7. 7.
    Wolinsky H, Glagov S (1964) Structural basis for the static mechanical properties of the aortic media. Circ Res 14: 400–413PubMedGoogle Scholar
  8. 8.
    Hutchins GM, Bulkley BH, Ridolfi RL, Griffith LSC, Lohr FT, Piasio MA (1979) Correlation of coronary arteriograms and left ventriculograms with postmortem studies. Circulation 56: 32–37Google Scholar
  9. 9.
    McNamara JJ, Norenberg RG, Goebert HW III, Soeter JR (1976) Distribution and severity of atherosclerosis in the coronary arteries. J Thorac Cardiovasc Surg 71: 637–640PubMedGoogle Scholar
  10. 10.
    Bulkley BH, Hutchins GM (1977) Accelerated “atherosclerosis”: A morphologic study of 97 saphenous vein coronary artery bypass grafts. Circulation 55: 163–169PubMedGoogle Scholar
  11. 11.
    Schwartz JN, Kong Y, Hackel DB, Bartel AG (1975) Comparison of angiographic and postmortem findings in patients with coronary artery disease. Am J Cardiol 36: 174–178PubMedCrossRefGoogle Scholar
  12. 12.
    Bahr GF, Bloom G, Friberg U (1957) Volume changes of tissues in physiological fluids during fixation in osmium tetroxide or formaldehyde and during subsequent treatment. Exp Cell Res 12: 342–343PubMedCrossRefGoogle Scholar
  13. 13.
    Zarins CK, Bomberger RA, Taylor KE, Glagov S (1980) Artery stenosis inhibits regression of diet-induced atherosclerosis. Surgery 88: 86–90PubMedGoogle Scholar
  14. 14.
    Zarins CK, Bomberger RA, Glagov S (1981) Local effects of stenoses: Increased flow velocity inhibits atherogenesis. Circulation 64 (Suppl II): 221–227Google Scholar
  15. 15.
    Glagov S, Grande J, Vesselinovitch D, Zarins CK (1981) Quantitation of cells and fibers in histologic sections of arterial walls: Advantages of contour tracing on a digitizing plate. In: McDonald TF, Chandler AB (eds) Connective tissues in arterial and pulmonary disease. Springer-Verlag, New York, pp 57–93CrossRefGoogle Scholar
  16. 16.
    Clarkson TB, Bond MG, Marzetta CA, Bullock BC (1980) Approaches to the study of atherosclerosis regression in rhesus monkeys: Interpretation of morphometric measurements of coronary arteries. In: Gotto AM Jr, Smith LC, Allen B (eds) Atherosclerosis V. Springer-Verlag, New York, pp 739–748CrossRefGoogle Scholar
  17. 17.
    Wissler RW, Vesselinovitch D, Schaffner TJ, Glagov S (1980) Quantitating rhesus monkey atherosclerosis progression and regression with time. In: Gotto AM Jr, Smith LC, Allen B (eds) Atherosclerosis V. Springer-Verlag, New York, pp 757–761CrossRefGoogle Scholar
  18. 18.
    Bomberger RA, Zarins CK, Glagov S (1981) Subcritical arterial stenosis enhances distal atherosclerosis. Resident Research Award. J Surg Res 30: 205–212Google Scholar
  19. 19.
    Bond MG, Adams MR, Bullock BC (1981) Complicating factors in evaluating coronary artery atherosclerosis. Artery 9: 21–29PubMedGoogle Scholar
  20. 20.
    Lyon RT, Zarins CK, Lu CT, Yang CF, Glagov S (1981) Arterial wall disruption by balloon dilatation: Quantitative comparison of normal, stenotic and occluded vessels. Surg Forum 32: 326–328Google Scholar
  21. 21.
    Zarins CK, Giddens DP, Balasubramanian K, Sottiurai V, Mabon RF, Glagov S (1981) Carotid plaques localize in regions of low flow velocity and shear stress. Circulation 64 (Suppl IV): 44Google Scholar
  22. 22.
    Young W, Gofman JW, Tandy R, Malamud N, Walter ESG (1960) The quantitation of atherosclerosis. I. Relationship to artery size. Am J Cardiol 6: 288–293Google Scholar
  23. 23.
    Crawford DW, Brooks SH, Barndt R Jr, Blankenhorn DH (1977) Measurement of atherosclerotic luminal irregularity and obstruction by radiographic densitometry. Invest Radiol 12: 307–313PubMedCrossRefGoogle Scholar
  24. 1.
    Thoma R (1886) Ueber die Abhangigkeit der Bindegewebsneubildung in der Arterienintima von den Mechanischen Bedingungen des Blutumlaufes. Virchows Arch [Path Anat] 104: 209–241CrossRefGoogle Scholar
  25. 2.
    Crawford T, Levene CI (1953) Medial thinning in atheroma. J Pathol Bacteriol 66: 19–23PubMedCrossRefGoogle Scholar
  26. 3.
    Harrison CV, Wood P (1949) Hypertensive and ischaemic heart disease: a comparative clinical and pathological study. Br Heart J 11: 205–229PubMedCrossRefGoogle Scholar
  27. 4.
    Stewart JD, Birchwood E, Wells HG (1935) The effect of atherosclerotic plaques on the diameter of the lumen of coronary arteries. JAMA 104: 730–733CrossRefGoogle Scholar
  28. 5.
    Bunce DFM (1964) Effect of intimai thickening on vascular capacity in vivo. JAOA 63: 869–870Google Scholar
  29. 6.
    Young W, Gofman JW, Tandy R (1960) The quantitation of atherosclerosis. 1. Relationship to artery size. Am J Cardiol 6: 288–293Google Scholar
  30. 7.
    Clarkson TB, Bond MG, Bullock BC, Marzetta CA (1981) A study of atherosclerosis regression in Macaca mulatta. IV. Changes in coronary arteries from animals with atherosclerosis induced for 19 months and then regressed for 24 or 48 months at plasma cholesterol concentrations of 300 or 200 mg/dl. Exp Mol Pathol 34: 345–368PubMedCrossRefGoogle Scholar
  31. 8.
    Bond MG, Adams MR, Kaduck JM, Bullock BC (1981) Effects of atherosclerosis on coronary artery size. Fed Proc 40: 773 (abstract)Google Scholar
  32. 9.
    Mann GV, Shaffer RD, Anderson RS, Sandstead HH (1964) Cardiovascular disease in the Masai. J Atheroscler Res 4: 289–312PubMedCrossRefGoogle Scholar
  33. 10.
    Mann GV, Spoerry A, Gray M, Jarashow D (1972) Atherosclerosis in the Masai. Am J Epidemiol 95: 26–37PubMedGoogle Scholar
  34. 11.
    Bond MG, Adams MR, Bullock BC (1981) Complicating factors in evaluating coronary artery atherosclerosis. Artery 9: 21–29PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1983

Authors and Affiliations

  • Christopher K. Zarins
  • Michael A. Zatina
  • Seymour Glagov
  • M. Gene Bond

There are no affiliations available

Personalised recommendations