Arteriosclerosis: Its morphology in the past and today

In a brief historical review the contributions of Rokitansky, Virchow, and Langhans concerning the pathogenesis of arteriosclerosis and the histogenetic puzzle of intimal cells classification are described. Then, some unresolved problems are discussed, especially the localization and distribution of arteriosclerotic plaques, the shape of endothelial cells and the orientation of their nuclei in correlation to local hemodynamic stress under normal and pathologic conditions. Some differences between experimental arteriosclerosis and arteriosclerosis in humans are illustrated by examples. The key role of the endothelium in the development of arteriosclerosis is well founded. According to recent investigations some cells on the surface of human arteriosclerotic plaques appear to be of non-endothelial origin. Arteriosclerosis seems to be a systemic disorder with multiorgan involvement. Individual cases, however, show significant differences in the distribution and extent of lesions. Today, arteriosclerotic research is focused on arteries being most important in clinical investigations. Nevertheless, there are also other arteries with severe arteriosclerotic lesions; for example, the degree of arteriosclerosis in periprostatic arteries is more pronounced than in coronary artery branches of the same size. Finally, the importance of primary prevention of arteriosclerosis is emphasized.