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Atherosclerosis: Clinical Perspectives Through Imaging pp 3–12Cite as

Insights into the Natural History of Atherosclerosis Progression

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Abstract

Pathology of high risk atherosclerotic plaque provides the basis for understanding the imaging and treatment of atherosclerosis. The earliest vascular change described microscopically are adaptive intimal thickening and fatty streaks, whereas pathologic intimal thickening are the first of the progressive plaques subtypes. Fibroatheromas are characterized by an acellular necrotic core, accumulated cellular debris and cholesterol monohydrate, and a lack of extracellular matrix. The development of the necrotic core is believed to originate from apoptotic macrophages. Thinning of the fibrous cap leads to plaques vulnerable to rupture, or thin-cap fibroatheromas. Overlying thrombosis can arise from one of several mechanisms including ruptures, erosion, or calcified nodules. Calcium within atherosclerosis is a common imaging target which increases with lesion progression and is present in greatest frequent in healed plaque ruptures and fibrous plaques. Thin cap fibroatheromas most frequently contain speckled calcification but may show heavily calcified areas or an absence of calcification. which is not very useful in diagnosing these lesions by calcium-based imaging. Coronary lesions with thrombi in the absence of rupture (erosions) exclusively show stippled or no calcification. Rupture in the absence of calcification is rare. In contrast, diffuse calcification is almost always associated with healed ruptures.

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Author information

Authors and Affiliations

  1. CVPath Institute, Inc., Gaithersburg, MD, USA

    Masataka Nakano M.D., Elena R. Ladich M.D., Frank D. Kolodgie Ph.D. & Renu Virmani M.D.

  2. Department of Cardiology/Medicine, William Beaumont Army Medical Center, Uniformed Services University of the Health Sciences, El Paso, TX, USA

    Jacob Stephen M.D.

  3. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Miranda C. A. Kramer M.D.

Authors
  1. Masataka Nakano M.D.
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  2. Jacob Stephen M.D.
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  3. Miranda C. A. Kramer M.D.
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  4. Elena R. Ladich M.D.
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  5. Frank D. Kolodgie Ph.D.
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  6. Renu Virmani M.D.
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Editor information

Editors and Affiliations

  1. MedStar Washington Hospital Center, Irving Street 110, Washington, 20010, District of Columbia, USA

    Allen J. Taylor

  2. Walter Reed Army Medical Center, Georgia Avenue, Washington, 20307, Washington, USA

    Todd C. Villines

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© 2013 Springer-Verlag London

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Nakano, M., Stephen, J., Kramer, M.C.A., Ladich, E.R., Kolodgie, F.D., Virmani, R. (2013). Insights into the Natural History of Atherosclerosis Progression. In: Taylor, A., Villines, T. (eds) Atherosclerosis: Clinical Perspectives Through Imaging. Springer, London. https://doi.org/10.1007/978-1-4471-4288-1_1

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  • DOI: https://doi.org/10.1007/978-1-4471-4288-1_1

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4287-4

  • Online ISBN: 978-1-4471-4288-1

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