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The neglected coronary atherosclerosis

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      Abstract

      A study of the natural history of coronary heart disease by means of gross inspection and light microscopy, carried out on 640 subjects aged 1–50 years who had died of violent accidents, revealed a grossly neglected coronary atherosclerosis. It included fibromuscular plaques, intimal necrotic areas and incorporated microthrombi present in the longitudinally opened main coronary arteries but not visible to the naked eye, and some atherosclerotic lesions visible to the naked eye but present in branch vessels unopened or not removed during routine autopsy. There were approximately 500 grossly neglected intimal necrotic areas and approximately 120 grossly neglected incorporated microthrombi; from a total of 809 atherosclerotic plaques 261 (32%) were grossly neglected. The topographic distribution and the number of neglected and non-neglected atherosclerotic plaques, in successive age groups, were analyzed. A small subsample, including 32 patients 52–79 years old, dead of coronary heart disease, was used to demonstrate the importance of the detection of obstructive atherosclerotic lesions in some usually unopened or not removed branch vessels for a realistic anatomo-clinic-cardioangiographic and ECG correlation.

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