Cerebrovascular disease

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Abstract
A comparative study of atherosclerosis of the coronary arteries, aorta, and cerebral arteries was carried out in 485 consecutive autopsy cases. A standard coding system was developed to grade the degree of involvement in each of these vessel groups, and the same investigator carried out all the studies in each case. Atherosclerotic changes occurred most frequently in the aorta, followed by the coronary and finally the cerebral arteries. By the 6th decade of life, only 9% of the cases failed to show changes in the aorta as compared to 20% for the coronary arteries and 31% for the cerebral vessels. By contrast the aorta showed the least amount of severe changes. On the other hand, the cerebral vessels, which were the least frequently involved, showed the most severe changes. This would suggest that atherosclerosis, once initiated, does not necessarily proceed at a uniform rate in all vessels and that a study of this process must include not only the possible etiologic factors but also thosethat tend to accentuate this process. For the individual case, there was often little correlation between the frequency and intensity of the atherosclerotic process in the different vessels. Such observations suggest caution in trying to predict the degree of atherosclerosis in one organ system from clinical or pathologic observations on another system. Generally, individuals with heart weights of over 450 g showed more frequent and severe atherosclerotic changes in the cerebral vessels in all age groups. Apparently, there was no accurate correlation between coronary atherosclerosis and death due to coronary thrombosis with myocardial infarction; 3 patients with only a single small plaque of coronary atherosclerosis died of coronary thrombosis, while 63% of the patients with severe coronary atherosclerosis had no clinical or pathologic evidence of coronary insufficiency. These findings would strongly indicate that any conclusions as to the incidence of coronary heart disease must be based on studies which differentiate between coronary atherosclerosis and coronary thrombosis and therefore must be determined by pathologic observations.