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Early and late morphologic changes in major epicardial coronary arteries after percutaneous transluminal coronary angioplasty

  • Bruce F. Waller
    Correspondence
    Address for reprints: Bruce F. Waller, MD, University Hospital, N-340, Department of Pathology, 926 West Michigan Street, Indianapolis, Indiana 46223.
    Affiliations
    From the Central Pathology Laboratory, Percutaneous Transluminal Coronary Artery Angioplasty Registry, Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland USA
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  • H.Joel Gorfinkel
    Affiliations
    From the Central Pathology Laboratory, Percutaneous Transluminal Coronary Artery Angioplasty Registry, Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland USA
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  • Felix J. Rogers
    Affiliations
    From the Central Pathology Laboratory, Percutaneous Transluminal Coronary Artery Angioplasty Registry, Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland USA
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  • Kenneth M. Kent
    Affiliations
    From the Central Pathology Laboratory, Percutaneous Transluminal Coronary Artery Angioplasty Registry, Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland USA
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  • William C. Roberts
    Affiliations
    From the Central Pathology Laboratory, Percutaneous Transluminal Coronary Artery Angioplasty Registry, Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland USA
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      Abstract

      Certain clinical and morphologic observations are described in 4 men who had PTCA of the left anterior descending coronary artery early (4 hours) or late (80, 90 and 150 days) before sudden death. Histologically, each of the 4 patients had the site of PTCA narrowed 76 to 95% in cross-sectional area by atherosclerotic plaque. The early PTCA patient had coronary artery dissection at the site of PTCA. Each of the 3 late PTCA patients had a decrease in the mean transstenotic coronary gradient (17, 38 and 43 mm Hg) and an angiographic increase in the left anterior descending coronary artery luminal diameter (55, 60 and 65%) at the time of PTCA. At necropsy, 80, 90 and 150 days later, the LAD coronary artery in the area of the PTCA in each patient was narrowed 76 to 95% in cross-sectional area by plaques. No cracks in plaques or other lesions that may have resulted from PTCA were identified histologically in the left anterior descending coronary artery in any late PTCA patient.
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