Coronary Vascular Disease (CVD, ASCVD)

General: Coronary vascular disease is generally assumed to mean atherosclerotic coronary artery disease, and is not commonly defined beyond that by many pathologists. However, not all coronary vascular disease is the same, and the variations are often relevant to the clinical picture. At least one text (*MPP 40, Virmani) likens the importance of differentiating features of plaques to differentiating features of a neoplasm.

There is a wide variation in overall incidence worldwide, with a higher rate in developed countries, presumed due primarily to dietary differences. Traditional risk factors include smoking, family history, high cholesterol, diabetes, and hypertension.

Gross: Somewhat varied, see specific types. Common features generally include luminal narrowing of one or more of the 4 major coronary arteries/arterial branches (left main coronary artery, left anterior descending coronary artery, left circumflex artery, and right coronary artery).

Microscopic: Varied, see specific types.
AHA Classification:

• Atherosclerotic lesions:
  • Type I
  • Type II
    • Type IIa
    • Type IIb
  • Type III
  • Type IV
  • Type V
    • Type Va
    • Type Vb
    • Type Vc
  • Type VI

Morphologic Modified AHA Classification:

• Nonatherosclerotic intimal lesions:
  • Intimal thickening
  • Intimal xanthoma
• Progressive atherosclerotic lesions:
  • Pathological intimal thickening
    • Erosion
  • Fibrous cap atheroma
    • Erosion
  • Thin fibrous cap atheromas
    • Plaque rupture
    • Calcified nodule
    • Fibrocalcific plaque

Differential Diagnosis:

Stains:

• Positive:
• Negative:
• Suggested, focused panel:

((()))*

Cases:

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