SummaryCoronary intraplaque hemorrhage up-regulates hemoglobin scavenger receptor CD163 expression on macrophages, and has an association with vulnerable plaque development. During percutaneous coronary intervention, mechanical plaque disruption exposes potentially embolic atheromatous contents from culprit plaque.In 37 patients with stable angina pectoris (SAP, n = 20) or acute coronary syndrome (ACS, n = 17), atherothrombotic debris was collected using a filter-based distal embolic protection device. We immunohistochemically determined CD14-positive macrophages and CD163-positive macrophages in filtered debris. We also examined the relation of CD14-and CD163-positive macrophages with culprit plaque volume and components evaluated with ultrasonic tissue characterization (VH-IVUS).The only significant difference in clinical characteristics between the two groups was in hs-CRP. In ACS, the percentage of CD14-and CD163-positive macrophages to the whole cells (%CD14 and %CD163, respectively) was significantly higher than that in SAP (20.1 ± 8.2 versus 8.8 ± 6.8%, P < 0.001 and 32.6 ± 18.9 versus 9.0 ± 3.8%, P < 0.001, respectively). In IVUS indices of culprit plaque, the remodeling index was significantly higher in ACS than in SAP. However, necrotic core component (%NC) in ACS was significantly higher than that in SAP. Furthermore, fibrotic component (%Fibrous) in ACS was significantly lower than that in SAP (56.1 ± 4.7 versus 60.1 ± 3.3%, P = 0.03). %CD14 and %CD163 had a significant positive correlation with %NC (%CD14: r = 0.40, P = 0.01 and %CD163: r = 0.45, P = 0.01), but only %CD163 was negatively correlated with %Fibrous (%CD163: r = −0.48, P = 0.01).These findings suggest that the presence of CD14-and CD163-positive macrophages may reflect plaque inflammation, NC expansion, and plaque vulnerability in patients with coronary heart disease. (Int Heart J 2015; 56: 150-156) Key words: Coronary artery disease, Intraplaque hemorrhage, Catheters B oth macrophage infiltration and hemorrhage into coronary plaque are associated with the development of atherosclerotic lesions and plaque instability. 1) Atherosclerosis largely involves macrophage-mediated inflammation driven by oxidized lipids.2) CD14 on the macrophage surface is bound to lipopolysaccharides, thereby activating macrophages to produce cytokines such as TNF-α, IL-1, and IL-6, which, in turn, serve as endogenous mediators of inflammation.3) In a previous pathological report, CD14-positive macrophages were more prevalent in atherosclerotic lesions compared with normal intimal regions of coronary arteries.3) Thus, CD 14-positive macrophages within the plaque indicates plaque with inflammatory macrophage inflammation.In advanced atherosclerosis, intraplaque hemorrhage (IPH) is an important contributor to lesion development and destabilization by several mechanisms, including the release of hemoglobin (Hb) into plaque. 4) Hb derived from IPH binds tightly to haptoglobin (Hp) to form an Hp-Hb complex. The Hp-Hb complex is exclusively cleared by macrophages ...