Abstract
We present the recent data confirming the angiographic and pathological efficacy of LDLapheresis for coronary atherosclerosis in a patient of familial hypercholesterolemia (FH) using collected data of a large number of cases and especially of one autopsy case. Change in coronary artery stenosis have been assessed angiographically in 37 FH patients in the LDL-Apheresis Regression Study (LARS) group of 13 institutions in Japan. Visual and Computer analysis confirmed definite regression in 21 segments. Fouteen of 37 patients (37.8%) who had received LDL-apheresis in combination with cholesterollowering drugs had at least one regressed segment without progressed segments. We pathologically examined at autopsy the coronary arteries in one FH patient who had received long-term LDL-apheresis therapy before death. The results showed the process of scarring of atheromatous plaque, suggesting pathological regression correlated with the angiographic regression shown in serial angiograms taken during LDL-apheresis. This suggested that the formation of an eccentric thickened wall lesion rich in collagen fiber prevented atheromatous plaque from tearing off. Such tearing off might cause to an acute coronary event. Aggressive cholesterol-lowering therapy based on LDL-apheresis can induce both angiographic and pathological regression in coronary atherosclerosis of FH patients.
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