Histopathology of Atherosclerosis Progression: What Imagers Need to Know

Chapter

Abstract

Atherosclerosis is a pathologically diverse disease with heterogeneous mechanisms of progression. Irreversible atherosclerotic plaques begin with smooth muscle cell-rich lipid pool lesions referred to as pathologic intimal thickening. It is reported that invasion of lipid pools by lesional macrophages leads to the development of more advanced fibroatheroma distinguished by localized areas of necrotic core. Key morphologic components that determine plaque vulnerability include plaque volume and remodeling, necrotic core size, and inflammatory invasion of the fibrous cap mainly by macrophages. Although the death of macrophages by apoptosis defines early necrosis, other factors such as intraplaque hemorrhage and defective clearance of cell debris are thought to result in necrotic core expansion and plaque instability. Free hemoglobin from extravasated red blood cells provides a viable source of oxidative damage and further recruitment of inflammatory cells. Intraplaque hemorrhage is associated with an increase in vasa vasorum both in the adventitia and in the intima. It has only recently been recognized that their identification might help reduce the incidence of sudden coronary death and acute myocardial infarction. Although much progress has been made in the understanding of atherosclerotic progression, we need better tools to identify the high-risk plaques in living patients with long-term follow-up to determine which lesions to be treated by interventional means or pharmacologically.

Keywords

Cholesterol Toxicity Ischemia Foam Cage 

Abbreviations

ACS

Acute coronary syndrome

AHA

American Heart Association

AMI

Acute myocardial infarction

CTO

Chronic total occlusion

CVD

Cardiovascular disease

Hb

Hemoglobin

HO-1

Hemoxygenase-1

Hp

Haptoglobin

HPR

Healed plaque rupture

ICAM-1

Intercellular adhesion molecule 1

MMP

Matrix metalloprotease

MPO

Myeloperoxidase

NO

Nitric oxide

PCI

Percutaneous coronary intervention

PIT

Pathologic intimal thickening

SCD

Sudden coronary death

SEM

Scanning electron microscopy

SMC

Smooth muscle cell

TCFA

Thin-cap fibroatheroma

TF

Tissue factor

VCAM-1

Vascular cell adhesion molecule 1

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Copyright information

© Springer Science+Business Media, LLC 2014

Authors and Affiliations

  1. 1.CVPath Institute, Inc.GaithersburgUSA

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