A Clinicopathologic Study on the Feasibility of Direct Surgical Treatment of Occlusive Coronary Arterial Disease

Abstract

The coronary arteries of 112 patients with an antemortem diagnosis of coronary arterial disease were studied at necropsy with regard to the feasibility of coronary endarterectomy for direct relief of the luminal narrowing. The patients ranged in age at the time of death from 40 to 87 years. The condition of the coronary arteries in 20 cases (18 per cent) was classed as pattern 1 (theoretically operable), in 58 cases (52 per cent) as pattern 2 (theoretically capable of palliation), and in 34 cases (30 per cent) as pattern 3 (theoretically inoperable). The youngest man who had a pattern 1 condition was 54 years of age, and of 26 men studied who were less than age 60 years, two had pattern 1 conditions, 12, pattern 2, and 12 pattern 3. Of the four women less than 65 years of age, none had pattern 1 conditions, two had pattern 2, and two had pattern 3. An impression gained from this study was that in general the most severe and diffuse lesions observed at necropsy are seen in the younger men who give clinical evidence of coronary arterial disease. Certain clinical features were analyzed in an attempt to find a correlation between these factors and the anatomic state of the coronary arteries. No clearly defined correlation could be discovered in this series. The role of direct surgical attack on the coronary arteries for relief of atherosclerosis does not appear to be an encouraging one from this study of clinical features and the final pathologic anatomy.