Morphological Analysis of Major Segments of Coronary Artery Occlusion: Importance in Myocardial Revascularization Surgery

Abstract

SUMMARY:Revascularization surgery should ensure morphological similarity between the coronary artery and the graft. This is an important factor for its duration and permeability. The aim of this study was to analyze the morphological characteristics and morphometrics of the coronary artery segments with greater occlusion. This was an observational, cross-sectional descriptive study that consisted of two phases. A macroscopic phase in which 11 cadaveric hearts were extracted and coronary dominance and length of the anterior interventricular artery (AIA), the right coronary artery (RCA) and the circumflex artery (CXA) were determined. In the microscopic phase a total of 77 segments of these arteries were obtained and the luminal diameter, wall thickness, and amount of elastic fibers and the presence and size of the atheroma were determined. Right coronary dominance was the most frequent. Total vessel length was 15.65±1.17 cm for the AIA, 12.67±2.02 cm for the RCA and 8.79±2.5 cm for the CXA. Diameters ranged from 2.3 mm in the proximal segments and between 1.1 mm to 1.8 mm in the distal segments. Wall thickness in the proximal segments was between 354 µm and 396 µm and in the distal segments it ranged from 120 µm to 305 µm. The amount of elastic fibers showed that they were muscular arteries. Atheromas were present in 35% in the CXA, and in 32.5% in the AIA and the RCA. The largest ones were found in the proximal segments. This study examined the morphology and morphometry of the segments of the coronary arteries that are more frequently occluded. It provides information on the most significant parameters to be considered for election of the vascular graft in myocardial revascularization surgery.

Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies

“…[13][14][15][16] There is insufficient evidence evaluating the specific segments of the coronary arteries where atheromas are most often located, or their size. It is reported that most atheromas occupy the proximal segments, 13,17) and these are usually the largest. 17) This is most likely because these segments have a greater luminal diameter.…”

“…It is reported that most atheromas occupy the proximal segments, 13,17) and these are usually the largest. 17) This is most likely because these segments have a greater luminal diameter. Atheromas' size is important because the severity of coronary artery disease is one of the factors that determine the graft selection for CABG.…”

“…17,20) A study in Turkish population reported a mean length of 9.38 ± 1.84 cm for AIA, 6.60 ± 1.53 cm in RCA, and 5.70 ± 1.20 cm in CX. 20) In contrast, a study involving a Mexican population reported mean lengths of 15.66 ± 1.12 cm for AIA, 12.69 ± 1.94 cm for RCA, and 8.89 ± 2.11 cm for CX.…”

“…20) In contrast, a study involving a Mexican population reported mean lengths of 15.66 ± 1.12 cm for AIA, 12.69 ± 1.94 cm for RCA, and 8.89 ± 2.11 cm for CX. 17) The luminal diameter is the most studied and irregular parameter. Most studies only analyzed a single segment, [19][20][21][22][23] whereas others analyzed the segments that are most often occluded 17) or an unspecified segment (Barry et al, 2007 24) ; Ballesteros and Ramirez, 2008 25) ) ( Table 1).…”

“…The most common is the right coronary dominance, with a prevalence of between 76% and 85%, followed by the balanced circulation with a frequency of 7.5%-17%, and finally left dominance with 6.8%-7.5% prevalence. [17][18][19] Morphological characteristics of each artery from several studies are described in Table 1.…”