Morphodynamic Interpretation of Acute Coronary Thrombosis, with Special Reference to Volcano-Like Eruption of Atheromatous Plaque Caused by Coronary Artery Spasm

Routine autopsy studies of hearts with coronary thrombosis, collected over a period of eleven years, showed unique morphologic features of rup ture of soft atheromatous plaques. These features include: (1) irregular luminar outline: angulation, invagi nation, upheaval, and/or wrinkles, (2) wavy outline of atheromatous cav ity, (3) volcano-like rupture with seepage or gushing of semiliquid ath eromatous contents into lumen, (4) cholesterol crystals arranged in rheo logic vector direction, (5) rupture of deeper intimal fibrous tissue, (6) one or multiple intimal upheavals, (7) fo cal thickening of contracted media, (8) vestige of volcano-like eruption with organized thrombus, and (9) old thrombotic occlusion with wavy ap pearance of thick intimal fibrous tis sue. The authors present a dynamic model of vasoconstriction or artery spasm that accounts for these fea tures and the rupture of soft ather omatous plaques.