What is the clinical evidence from this study?

Study design: Observational. Population: Chronic total coronary artery occlusions (n=61). Intervention: Lesion age (older vs younger CTOs) vs. Younger lesions (<1 year). Primary outcome: Histologic composition and neovascular channel pattern.

What question did this study set out to answer?

To examine age-related alterations in histologic composition and neovascular channel architecture within angiographic chronic total coronary artery occlusions.

August 7, 2026Journal of the American College of Cardiology

Histologic Correlates of Angiographic Chronic Total Coronary Artery Occlusions

Q: What are the key findings of this study?

Older chronic total occlusions were associated with increased fibrocalcific intimal plaque (p=0.008), whereas younger lesions had more cholesterol and foam cell-laden plaque (p=0.0007).

Q: What question did this study set out to answer?

To examine age-related alterations in histologic composition and neovascular channel architecture within angiographic chronic total coronary artery occlusions.

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Key result

Older chronic total occlusions are linked to greater fibrocalcific plaque, while younger lesions show lipid-rich histology.

n=61

Population

61 patients from autopsy studies who had undergone coronary angiography within 3 months of death, excluding…

Design

Cross-sectional

Authors

SSSanjay S. SrivatsaMayo Clinic WEWilliam D. EdwardsMayo Clinic CBChristine M BoosMayo Clinic in Arizona

Discussion

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Implication

Age-related changes in CTO intimal plaque composition from cholesterol-laden to fibrocalcific, along with adventitia-derived neovascular channel growth, may explain the adverse revascularization profile of older CTOs.

Key Points

To examine age-related alterations in histologic composition and neovascular channel architecture within angiographic chronic total coronary artery occlusions.
Analyzed 96 angiographic chronic total occlusions from autopsies of 61 patients who had undergone coronary angiography within 3 months of death, excluding abrupt plaque ruptures.
Quantified intimal plaque composition, cellular inflammation, and neovascular channel distribution across vascular layers relative to lesion age.
Cholesterol- and foam cell-laden intimal plaques predominated in younger lesions (p = 0.0007), whereas fibrocalcific plaques significantly increased with lesion age (p = 0.008).
Intimal neovascular channels originated from adventitial vasa vasorum, with channel number and caliber quantitatively linked to intimal cellular inflammation (p = 0.0001), which exceeded medial (p = 0.0001) and adventitial (p < 0.001) inflammation across all ages.
In lesions older than 1 year, adventitial and intimal neovascular channel counts equalized, both significantly outnumbering channels located in the media (p = 0.0001) and recanalized lumen (p = 0.003).

Study Design

Type

Observational (n=61)

Structured PICO

Population

61 patients with 96 angiographic chronic total coronary artery occlusions who underwent coronary angiography within 3 months of death.

Outcome

Histologic composition as a function of lesion age, and neovascular channel (NC) pattern as a function of lesion age and intimal plaque (IP) compositionsurrogate

Cite This Study

Srivatsa et al. (1997) conducted an observational in Chronic total coronary artery occlusions (n=61). Lesion age (older vs younger CTOs) vs. Younger lesions (<1 year) was evaluated on Histologic composition and neovascular channel pattern. Older chronic total occlusions were associated with increased fibrocalcific intimal plaque (p=0.008), whereas younger lesions had more cholesterol and foam cell-laden plaque (p=0.0007).

synapsesocial.com/papers/6a75a3038cf48732f0c95f18 https://doi.org/10.1016/s0735-1097(97)00035-1

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Histologic Correlates of Angiographic Chronic Total Coronary Artery Occlusions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Histologic Correlates of Angiographic Chronic Total Coronary Artery Occlusions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider