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The endothelium is a protective one cell layer lining the surface of the artery lumen.Endothelial cells perform many complex functions and are capable of modulating vascular tone, as well as inflammatory and thrombotic processes.
The following figures were constructed from a video Tom Dayspring produced in one of his stellar lectures on the development of atherosclerosis.
After performing histological analyses of coronary artery sections, Glagov et al.
reported that early atherosclerosis was characterized by plaque accumulation in the vessel wall and enlargement of the external elastic membrane (EEM) a change in lumen size.
I’ve broken the video down into 20 or so steps which show the transition from a completely normal endothelium (i.e., at birth) through myocardial infarction.
Each figure is preceded by a brief explanation of its content.
As atherosclerosis progressed, they found that plaque continued to accumulate in the vessel wall until the lesion occupied approximately 40% of the area within the EEM. These findings have since been confirmed by intravascular ultrasound (IVUS).
Due to the complex remodeling that occurs in the earlier stages of atherosclerosis, coronary angiography, which only visualizes the lumen, tends to the degree of atherosclerosis.
I had dinner with Tom’s son and his wife once and I described Tom to them as a national treasure. He is a nationally-recognized educator and his writing and presentations are devoured by fanatics like me across the globe.
With Tom’s permission, I’ve deconstructed a video he put together into a series of figures which I’ll use to begin this discussion of how atherosclerosis actually takes place.
Consequently, prevailing opinion held that coronary angiography would be able to gauge the atherosclerotic process at all stages of disease.
However, in 1987, Glagov and colleagues proposed an alternative model of atherosclerosis development.
To put this in perspective, a woman in the United States is 7 to 8 times more likely to die from heart disease than she is from breast cancer.