Remodeling of the atherosclerotic arterial wall: a determinant of luminal narrowing in human coronary arteries

Background The type of remodeling of the human femoral artery (enlargement or shrinkage) is related to the percentage luminal stenosis.Objective To assess how local changes in vessel size, together with plaque load, determine luminal narrowing in atherosclerotic human coronary arteries.Methods We obtained 576 segments of 28 coronary arteries from 10 patients who had died from noncardiac causes. The lumen area and area circumscribed by the internal elastic lamina (IEL) area, a measure of local vessel size in each histologic cross-section were measured, and the mean lumen diameter and mean IEL diameter were calculated. To correct for arterial tapering, expected reference diameter values were calculated at the same location using linear regression of all data points along the artery. The IEL diameter and lumen diameter were expressed as percentages of the calculated IEL diameter and lumen diameter at the same location (percentage lumen diameter stenosis and relative IEL diameter, respectively).Results We found a negative relation between the relative IEL diameter and the percentage lumen diameter stenosis. On average, a narrower than expected lumen diameter was accompanied by a smaller than expected IEL diameter. A larger than expected lumen diameter was accompanied by a larger than expected IEL diameter. This relation was found for the left anterior descending, circumflex, and right coronary arteries (y = −0.60x + 105.33, r = 0.48; y = −0.45x + 100.69, r = 0.84; and y = −0.39x + 101.84, r = 0.61, respectively, all P