Coronary Radiography and Endarterectomy

IN 1925, what was probably the first comprehensive clinicopathologic study of coronary heart disease was reported from this medical school by Benson and Hunter.' It is more than a quarter of a century later. Though the personnel have changed and though literally thousands of investigators have added to understanding of the problem, the basic concepts of coronary disease then elucidated have not been changed. Less fortunately, neither has the therapy. In view of progress in cardiovascular surgery,2the current state of angiography,9-16 and the frequency and mortality of coronary arterioselerosis17 it is now necessary to examine the feasibility of surgical removal of the intravascular obstruction. The present report describes the methods and findings of a continuing 3-year attempt to appraise the problems as well as the potential of such surgery. The planned objective was to use autopsy hearts in determining (a) whether the functional anatomy and carrying capacity of the diseased coronary bed could be improved by surgery, (b) whether coronary angiography offered reliable preoperative means for defining the lesion. In order to answer these questions, consideration had to be given to the severity and distribution of lesions as well as their physiologic and anatomic correlation with evidence of myocardial isehemia.