Localization of Early Atherosclerotic Lesions in an Arterial Bifurcation in Humans

Abstract

Kjiirnes. M., Svindland A., Wallee L., Wille. S. 0. Localization of early atherosclerotic lesions in an arterial bifurcation in humans. Acta path. microbiol. scand. Sect. A, 89: 35-40, I98 I.The detailed localization of early atherosclerotic lesions in arterial bifurcations was studied in 3 3 brachiocephalic arteries obtained from autopsies of young persons who had suffered a violent and sudden death. Drawings of the sudanophilic lesions in the vessel wall were fed to a computer, scaled to a standardized size and shape, and added together. The results are presented as contour lines connecting points with equal frequency of early lesions. The distribution of the early lesions reveals a distinct pattern: The early lesions start to develop on the outer walls of the bifurcation, while the inner walls downstream from the flow divider are kept free as are also the lateral walls. These results are clearly in conflict with Fry's shear stress hypothesis, while they seem to support Caro's hypothesis of inhibition of local diffusional transport. The results are also at variance with results obtained in most animal models, suggesting that the process which takes place in the vessel wall in these animals may be different from human atherosclerosis.

Discovery of the Role of Wall Shear in Atherosclerosis

“…Kjaernes et al, 26 Svindland, 27 Grottum et al, 28 and Svindland and Walloe 29 studied postmortem specimens of, respectively, the brachiocephalic arteries, the left main coronary bifurcation, and aortic intercostal ostia of human subjects who had died violent or noncardiovascular deaths. Among their conclusions were that lesions were present preferentially in regions expected to experience low-wall shear, that the pattern of distribution was very similar for sudanophilic and fibrous plaques, and that it differed from results obtained in most animal models.…”

“…A controversy was perceived between high and low wall shear as causative factors for atherosclerosis in adult human beings 23-25 ; we cite some of the early papers which confirmed the preferential occurrence of lesions in low wall shear regions. We wish also to state that no difference in scientific viewpoint ever affected the friendship of those closely involved.Kjaernes et al, 26 Svindland, 27 Grottum et al, 28 and Svindland and Walloe 29 studied postmortem specimens of, respectively, the brachiocephalic arteries, the left main coronary bifurcation, and aortic intercostal ostia of human subjects who had died violent or noncardiovascular deaths. Among their conclusions were that lesions were present preferentially in regions expected to experience low-wall shear, that the pattern of distribution was very similar for sudanophilic and fibrous plaques, and that it differed from results obtained in most animal models.…”

Differentially Expressed Soluble Proteins in Aortic Cells from Atherosclerosis-Susceptible and Resistant Pigeons

“…along the arterial tree (Kjaernes, 1981). Avian lesions (Siller, 1965), and especially pigeon lesions (St. Clair, 1998;Moghadasian et al, 2001), have been described as having greater similarities to human atherosclerosis than any other animal model of heart disease, including mice, monkeys, and swine.…”

Spontaneous Atherosclerosis in Pigeons: A Good Model of Human Disease

“…Foam cells develop into fatty streaks which progress into mature plaques in the absence of elevated plasma cholesterol and other traditional risk factors (Wagner, 1978;Wagner et al, 1979). These non-induced atherosclerotic lesions are morphologically and ultrastructurally similar to those seen in humans and occur at parallel anatomical sites along the arterial tree (Cornhill et al, 1980a(Cornhill et al, , 1980bHadjiisky, et al, 1991;Kjaernes et al, 1981). Multiple studies have clearly demonstrated that susceptibility in the WC resides at the level of the arterial wall (St. Clair et al, 1986;Wagner et al, 1973Wagner et al, , 1979).…”

“…Atherosclerosis is the most common form of heart disease, a general term encompassing a variety of pathologies affecting the heart and circulatory system. More specifically, atherosclerosis is a disease of the blood vessel itself, and is most likely to develop at branch points and other regions of low shear stress along the arterial tree, such as the celiac bifurcation of the aorta, and in coronary and carotid arteries (Bassiouny et al, 1994;Kjaernes et al, 1981). The disease is a chronic and multifactorial result of both environmental and genetic factors, as well as their interactions (Breslow, 2000;Moghadasian et al, 2001).…”