Occurrence of coronary ostial stenosis in a necropsy series of myocardial infarction, sudden death, and violent death.

Abstract

A postmortem coronary angiography technique employing aortic injection of contrast medium and double contrast visualization of the aortic bulb and large epicardial coronary trunks was applied to the study of coronary ostia in a series of I24 deaths from acute myocardial infarction and a series of 89 sudden deaths without recent infarction and 42 violent deaths. A stenosis of50 per cent or more of the lumen was found in the right ostium in 45 per cent and in the left ostium in 8 per cent of infarct cases. The correspondingfigures in sudden deaths were 37 per cent on the right and 4 5 per cent on the left side, and in violent deaths 7 per cent in the right ostium and none in the left. Most ostial stenoses were caused by coronary atherosclerosis. In 9 patients, two with a recent infarct and 7 sudden deaths, an ostial stenosis was the only stenosed site in the coronary arterial tree. Of these 9 patients, 7 were known to have sufferedfrom symptomatic heart disease during life, chest pain on effort and arrhythmias being the most common complaint.There are few documented data concerning the occurrence and significance of coronary ostial changes in patients with ischaemic heart disease. The reason for this has certainly been the difficulty which is associated with the reliable demonstration of the status of coronary ostia. The funnel-shaped coronary orifice in the aortic wall may be visualized in the clinical cine-coronary arteriogram if the semiselective injection technique of the contrast medium is applied and the radiographs are taken in suitable projections (Paulin, I964). Even then, the contrast medium itself may conceal possible pathological changes. The selective catheterization of each coronary ostium is used nowadays in most centres for clinical angiographic study of the coronary arteries (Judkins, I967; Valle, I973). The selective technique does not demonstrate changes in the ostia.At necropsy the estimation of stenosis in coronary orifices may be difficult with the naked eye. In most postmortem coronary angiographic techniques a cannula or a needle is inserted into the main coronary arteries for the injection of contrast medium The drawback of such a technique is that the aortic ostium of the coronary artery is not visualized in the radiograph. Attempts have been made in necropsy studies to assess the possible stenosis of the ostium using graduated probes (Schwartz and Mitchell, I962; Fulton, I965).A postmortem coronary angiography technique employing aortic injection of contrast medium and double contrast visualization of large epicardial coronary trunks (Rissanen, 1970) was applied in the present study for the examination of aortic coronary ostia in a series of deaths from acute myocardial infarction, a series of sudden deaths without recent infarction, and a control series of violent deaths. Material and methodsThe present study formed part of a series of pathoanatomical examinations in a community-wide study of the Ischaemic Heart Disease Register, which was carried out in Helsinki in 1970 (Romo, I973; Ri...

Isolated coronary ostial stenosis

“…middle-aged females [9] and it is interesting to speculate that in some patients it may be due to unrecognized ostial stenosis. However, in most such patients the prognosis is excellent, whereas the rather rapid onset and progression of symptoms in our patients and the reported occurrence of sudden death in cases of ostial stenosis [6] would suggest that patients with this lesion are at high risk and resemble those with left main stem disease in this respect. Indeed cases of ostial stenosis have been included in reviews of left main stem disease for whom the poor natural prognosis and high risk of catheterization is well known [7].…”

“…. " Finally, Rissanen [6] used a postmortem angiography technique to study the coronary ostium in a series of 124 patients dying from myocardial infarction, 89 cases of sudden death without recent infarction and 42 cases of violent death. In nine patients (two dying from recent infarction and seven sudden deaths) ostial stenosis (eight right coronary artery, one left coronary artery) was the only lesion present in the coronary arterial tree and of these nine patients eight were female aged between 47 and 64 years.…”

“…This is a striking difference from the usual 7:l male preponderance in atherosclerotic coronary artery disease. Isolated ostial stenosis occurring in two middle-aged females has been described by Pritchard et al [5] and eight of nine cases with isolated ostial stenosis reported in a postmortem study by Rissanen [6] were female. The condition may represent a specific disease entity not previously recognized.…”

Angiographic and Clinical Outcomes After Sirolimus-Eluting Stent Implantation to De Novo Ostial Lesion of the Right Coronary Artery A Retrospective Study

“…Therefore, not only early but also late elastic recoil occurred frequently, although larger acute gain was obtained after stent implantation with high pressure dilatation (Table 2). 9,[26][27][28] In addition, it is reported that the tissues at the RCAos are frequently sclerotic due to the combination of calcification and fibrosis. Usually, this might implicate in-stent underexpansion 20,21 and/or nonuniform expansion, 29 which are the major intravascular findings of ISR after SES implantation.…”

“…Thus, for these reasons for restenosis, although SES exerted greater benefits than BMS to RCAos (eg, 55% reduction of binary restenosis and 63% reduction of TLR) ( Table 2), RCAos became the most powerful predictor of TLR of SES 3,4 and, in turn, became a limitation of PCI. Therefore, an histological assessment revised from previous reports 26,27 suggests that in order to ascertain the impact of sirolimus for RCAos, a detailed intravascular estimation, particularly at RCAos (limitation is discussed later), and mechanical effects, such as hinge motion and stent fracture, after stent implantation to RCAos (limitation is discussed later) must be identified to overcome the limitation of PCI at RCAos.…”