Figure 4

Coronary atherosclerosis. Different aspect of a severe, pin-point lesion (arrow). Plaque with prevailing atheroma (A) or fibrosis (B). Plaque with pale, large zone of proteoglycan accumulation (C) or with small atheroma plus hemorrhage and proteoglycans associated with critical stenosis occluded by an acute thrombus (D). Sequence in the same plaque of "rupture" (E) followed by severe hemorrhagic atheroma with minimal, linear lumen (arrow) without occlusion(F). Occlusive thrombosis connected with hemorrhagic atheromasia at the site of a critical stenosis (G). Semilunar stenosis (H) with a normal half wall and minor lumen reduction. The concept of vessel wall remodeling to compensate plaque growth has not any support (very low frequency of this type of lesion versus severe concentric lumen reduction in the natural history of coronary heart disease).