Last update:
21-Jul-2000

Arch Hellen Med, 16(6), November-December 1999, 557�568

REVIEW

Coronary atherosclerosis
Problems and future outlook

H. BOUDOULAS
The Ohio State University, Columbus, Ohio, USA

Advances in the diagnosis and management of coronary atherosclerosis over several decades have resulted in a significant reduction in morbidity and mortality from the disease. Despite this progress, coronary atherosclerosis still remains the number one cause of death in industrialized countries and it is apparent that there remain significant problems related to its diagnosis and management. The main problems are: the disease is diffuse and progressive with unpredictable progression; the diagnostic techniques, especially the noninvasive techniques, are not accurate and cannot identify the atherosclerotic plaque prone to rupture; the use of cardiopulmonary bypass for the surgical revascularization of the myocardium is associated with significant risk; the vein grafts used for bypass are prone to thrombosis and atherosclerosis; the restenosis rate after angioplasty or stent implantation is very high; current revascularization techniques do not improve the function of medium and small size vessels; stratification of patients according to risk factors is inadequate, since approximately 50% of patients with coronary atherosclerosis have none of the so-called �traditional� risk factors. Significant promising advances which in the near future will change the approach to the management of coronary atherosclerosis include: de ment of the diagnostic techniques and accurate definition of the unstable plaque; coronary bypass surgery with out use of cardiopulmonary bypass; genetic manipulation of vein grafts to prevent thrombosis and atherosclero sis; use of arterial conduits which give good long-term results instead of vein; improvement of the function of medium and small size vessels by promoting angiogenesis; genetic analysis for better patient stratification; management based on genetic analysis, i.e., application of pharmacogenetics; and finally, definition of the etiology of the disease will lead to not only cure but also prevention of coronary atherosclerosis.

Key words: Acute ischemic syndrome, Atherosclerosis, Atherosclerotic plaque, Coronary vessels, Plaque rupture, Thrombosis.