Structural features of the endothelium interaction with the blood cellular elements during atherosclerotic processes of varying severity in the coronary arteries have been analyzed from the data of early sections and coronary artery biopsy specimens. The status of the endothelium has been uniform in macroscopically unchanged sites irrespective of the coronary atherosclerosis severity. A stable characteristic symptom of the initial stages of atherogenesis is the formation of crater-like defects and monocyte adhesion. Scanning electron microscopy has shown for the first time the presence of echinocytes in the blood of coronary patients and adhesion of these cells at the site of the endothelial monolayer destruction. The formation of microthrombi at the site of endothelial destruction is not a stable symptom of the initial stages of atherogenesis. Endothelial destruction and regeneration, aided by the platelets, can be observed at all stages of atherogenesis.

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