Glagov phenomenon
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vanessa Cherniauskas, M.D. [2]
Synonyms and keywords: Glagov's phenomenon; Glagov's remodeling
Overview
Glagov phenomenon denotes the adaptive enlargement of coronary artery in response to plaque formation. Lumen area is preserved during the early stage of coronary artery disease and lumen encroachment becomes evident until the lesion occupies greater than 40% of the internal elastic lamina area.[1] Thus, angiography-detectable stenosis and significant functional impairment may be delayed despite the presence of a fairly sizable atherosclerotic plaque.
Historical Perspective
Based on the study of human left main coronary arteries obtained at autopsy by Seymour Glagov et al. in 1987,[1] it was concluded that during the initial development of atherosclerosis, coronary artery enlarges in parallel with the growth of plaque and a nearly normal cross-sectional lumen area is maintained, as the internal elastic lamina area directly correlates with the plaque area. Lumen area starts to diminish in close relation to the percentage of stenosis, defined as the ratio of plaque area to internal elastic lamina area, for values above 40 percent.
Clinical Significance
Atherosclerosis is a disease of the vessel wall. Since coronary angiography only allows visualization of the arterial lumen, atherosclerotic burden and disease extent may be underestimated due to the compensatory coronary enlargement in response to plaque formation which preserves the ordinary lumen size. Arterial narrowing becomes appreciable on coronary angiography until the plaque occupies greater than 40% of the internal elastic lamina area. Therefore, a normal-sized coronary artery on angiogram does not rule out the presence of atherosclerotic plaque nor certainly indicates a small plaque burden.