Coronary Radiography and Endarterectomy

Abstract

Postmortem angiography, kerosene perfusion, latex mass-injection radiographic studies and the conventional methods of anatomic pathology have been used in a study of coronary artery disease in 189 hearts, 88 of which had myocardial infarction associated with coronary arteriosclerosis. Analysis was directed to ascertain whether sclerotic lesions appeared to be amenable to surgical removal and whether such removal is likely to result in an increased flow of blood to the myocardium. Affirmative conclusions to these questions were reinforced by 42 postmortem coronary resections done in 31 cases. Fluidtight closures permitted follow-up perfusion studies in 25 successful resections done for the relief of coronary luminal narrowing, and in 16 of these significant increase in the perfusion rate resulted. Twelve of these 25 were endarterectomies, and increased perfusion rates were achieved in 10 of them. From the logical standpoint, direct relief such as appears mechanically feasible through surgical endarterectomy offers an attractive therapeutic approach to myocardial ischemia from coronary arteriosclerosis. The presence of multiple main-vessel lesions and of distal small-branch disease does not preclude significant improvement; these are not contraindications to such surgery. In view of the frequency and mortality of coronary arteriosclerosis and because of the inadequacies of other methods of therapy in use today, the clinical trial of a direct attack upon the occluding lesion appears to be warranted. Current clinical failures provide opportunities while external artificial circulation and other methods for left ventricular assistance or bypass pumping provide means for gaining surgical experience and offering at least a slim chance to patients whose lives would otherwise be lost. Radiographic studies of the coronary system will be essential to any surgical attack likely to succeed.