By D. Eugene Strandness (auth.), M. Gene Bond Ph.D., William Insull Jr. M.D., Seymour Glagov M.D., A. Bleakley Chandler M.D., J. Fredrick Cornhill D. Phil. (eds.)
This quantity is the fabricated from a February 1982 convention, cosponsored by way of the yank center organization, the nationwide Institutes of health and wellbeing, and the Bowman grey tuition of drugs, which tested concepts for delineating quantitatively the average historical past of atherosclerosis. opposed to the heritage of present pathologic and medical wisdom of atherosclerosis, invasive and noninvasive evaluative tools now in use and below improvement are surveyed extensive. Correlative clinicopathologic reports of atherosclerosis pose distinctive questions with appreciate to either luminal and plaque features which are addressed during this quantity. An previous observa tion, in accordance with the exam of arterial casts, advised that the so-called nodose lesion of atherosclerosis can be first and foremost flattened into the wall of a weakened, dilated artery, instead of raised into the lumen. this is often now absolutely proven in vivo by means of ultrasonic and different imaging innovations. The morbid anatomist is challenged anew to explain lesions as they're prone to ensue in vivo. to accomplish nearer correlation with normal stipulations, perfu sion fixation of arteries below arterial strain is turning into extra universal and has already validated extra legitimate quantita tion of the composition and configuration of lesions. whereas the noninvasive tools of B-mode and Doppler ultrasound are compatible just for the scientific learn of superficial arteries, equivalent to the carotid or femoral, the hot and comparatively noninvasive strategy of intravenous electronic subtraction angio graphy could be successfully used for the exam of deep structures, resembling cerebral vessels.
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Extra resources for Clinical Diagnosis of Atherosclerosis: Quantitative Methods of Evaluation
A typical advanced raised plaque consists, on transverse cross section, of a so-called necrotic center or core and an overlying band of tissue, termed the fibrous cap. The necrotic center is usually a conglomerate of several components and may include cells, cell debris, formed matrix fibers, and other extracellular proteins derived from cells or plasma, lipids in amorphous and/or crystalline form within and outside of cells, and calcific deposits. S. Glagov and C. K. Zarins 18 Fig. 4 Lesions viewed en face in longitudinally opened superficial femoral arteries.
Glagov and C. K. Zarins 30 accessible to the probe but lesser stenoses may be overlooked. Sensitivity may be somewhat better in exposed vessels. Estimates of stenosis based on determinations by spectral analysis can be related to relatively small decreases in lumen diameter, on the order of 25%, but are subject to error in relation to branch angles, bends, departures from axisymmetry of lesions and other geometric variables. This technique alone does not permit characterization of lesion composition, complication, or extent of disease, except that multiple stenoses in one or more vessels can be detected and changes with time in both number and severity of stenosis may be estimated.
As described by Blankenhorn and Brooks (6), the relationship between the number of subjects required in a trial and the other design factors mentioned above is shown in the equation below. N = where K o PPV Mp D :2 [pPV + ( ~ ) 2] (1) constant dependent on the desired statistical power and significance level for the trials, expected percent rate of change of atherosclerosis due to the treatment, patient-to-patient percent variance of atherosclerosis change without treatment. the percent measurement precision, and the trial duration.