Intimal neovascularization in human coronary atherosclerosis: its origin and pathophysiological significance.

To investigate the histopathological characteristics of the newly formed vessels in the atherosclerotic intima of human coronary arteries, we conducted postmortem angiography in 31 cases, including 11 with myocardial infarction. Vessels were examined three-dimensionally under the stereoscope. In addition, we evaluated 25 anterior descending coronary arteries unrelated to the occurrence of myocardial infarction by light microscopy using 3-mm stepwise sections and 5-microns serial sections. Histological alterations were analyzed morphometrically to determine the correlation between the degree of intimal neovascularization and the growth of the endothelium into the atherosclerotic intima from the adventitia or lumen. There was a significant positive correlation between the density of new vessels in the intima and the incidence of luminal stenosis, the extent of chronic inflammatory infiltrate, the formation of granulation tissue, or the atheromatous changes, whereas the vascular density decreased in the extensively hyalinized and calcified intima. The newly formed intimal vessels originated mainly from the adventitial vasa vasorum and also partly from the proper coronary lumen. The intimal vessels that originated from the adventitia occurred approximately 28 times more frequently than those that originated from the luminal side. The frequency of former vessels increased as the luminal stenosis became more severe, whereas the latter vessels were found most frequently in the presence of 40% and 50% stenosis. Vessels originating from the proper lumen were more often associated with fresh or old hemorrhage. We conclude that intimal neovascularization largely originates from the adventitia and is closely associated with the extent of coronary stenosis and the histological inflammatory reaction.