CAC in CAD

Q:  In coronary artery disease (CAD), Coronary Artery Calcium (CAC) deposition occurs mostly in which layer of the vessel? (select one)

A) intimal layer 

B) medial layer 

Answer: A

This question highlights the distinction between etiologies of calcium deposition in coronary and noncoronary diseases.

CAC deposition occurs due to smooth muscle cell apoptosis. It begins as microscopic calcifications from 0.5 to 15 micrometers, and as the disease progresses can grow up to  >3 mm. 

Most CAC occurs in the intimal layer of the coronary arteries. But, in patients with non-coronary diseases such as kidney insufficiency and hyperparathyroidism, it is usually seen in the medial layer of the vessel.  Said that patients with noncoronary diseases may have high risk of cardiac events.

#cardiology

References:

1. Mori H, Torii S, Kutyna M, et al. Coronary Artery Calcification and its Progression: What Does it Really Mean? JACC Cardiovasc Imaging 2018; 11:127.

2. Burke AP, Weber DK, Kolodgie FD, Farb A, Taylor AJ, Virmani R. Pathophysiology of calcium deposition in coronary arteries. Herz. 2001 Jun;26(4):239-44. doi: 10.1007/pl00002026. PMID: 11479935.