The Central Problem
The therapeutic problem in coronary artery disease is created by the existence of structural coronary narrowing or complete occlusion causing diminished coronary blood flow. The reestablishment of a satisfactory blood supply then becomes the central objecttive.
The Nature of the Occlusion
Excluding the more unusual causes, such as embolism, syphilitic narrowing of the coronary ostia, necrotizing arteritis, or calcific aortic stenosis impinging on the ostia, one deals with coronary atherosclerosis as the causative process in more than 90% of patients with angina pectoris or acute myocardial infarction. An effective therapeutic approach must be based on knowledge of the anatomic changes and of the pathologic physiology of the atherosclerotic process.
The Anatomic Characteristics of Coronary Atherosclerosis.
—The obstructing atherosclerotic lesions are arterial, not venous, and reside in the main stems and primary branches. They are almost entirely epicardial. The highest incidence of occlusions is not directly at the