Near simultaneous atherothrombotic occlusion of two coronary arteries challenges the theory of the single vulnerable plaque
During surgery, 21 patients undergoing coronary artery bypass for unstable angina were found to have "red lines" overlying one or more coronary arteries. Adventitial biopsies showed vascular distention and inflammatory cells. The group was followed for an average of 54 months (14 to 68 months). There were no operative deaths. Recurrent myocardial ischemia developed in 38.1% (8/21); recurrent angina developed in 23.8% (5/21) and are being treated medically; myocardial infarction occurred in 9.5% (2/21); and reoperation was required in 4.8% (1/21). There was also one late death from a brain tumor. We suggest that the presence of adventitial inflammation may represent an aggressive, variant form of atherosclerosis and a less favorable clinical prognosis.