IntroductionA ruptured atherosclerotic plaque leads to exposure of deeper layers of the plaque to flowing blood and subsequently to thrombus formation. In contrast to the wealth of data on the occurrence of thrombi, little is known about the reasons why an atherosclerotic plaque is thrombogenic. One of the reasons is the relative inaccessibility of the atherosclerotic plaque. We have circumvented this problem by using 6-,gm cryostat cross sections of human coronary arteries. These sections were mounted on coverslips that were exposed to flowing blood in a rectangular perfusion chamber. In normal-appearing arteries, platelet deposition was seen on the luminal side of the intima and on the adventitia. In atherosclerotic arteries, strongly increased platelet deposition was seen on the connective tissue of specific parts of the atherosclerotic plaque. Despite the evident importance of this issue, few studies exist about the thrombogenicity of the atherosclerotic plaque. Coagulation tests with tissue extracts of atheromas (6, 7) and addition of atheroma suspension to blood in a rotating tilted closed plastic tube ("Chandler loop" model) (7-9) tended to show less thrombogenicity than expected (6,8,9). More recently histochemical studies showed that there is more tissue factor in an atherosclerotic plaque than in the normal vessel wall (10, 11). Perfusion studies with blood over hyperlipidemic rabbit atherosclerotic aortic subendothelium showed decreased platelet adhesion ( 12), whereas the injured artificially created neointima in rabbits was more thrombogenic than the injured normal intima ( 13 ). A problem of most studies is that the relevant deeper layers ofthe atherosclerotic plaque are relatively inaccessible to flowing blood. Artificial rupture of the atherosclerotic plaque in order to bring blood in contact with deeper layers has the disadvantage that it is difficult to evaluate the actual thrombogenicity because ofthe disturbed blood flow pattern. We have circumvented these problems by using cryostat cross sections of postmortem human coronary arteries. These cross sections were mounted on coverslips and anticoagulated blood was perfused over them in a rectangular perfusion chamber ( 14). These studies showed platelet deposition and thrombus formation particularly on the luminal side of the subendothelium and on the adventitia in normal vessels and strongly increased platelet deposition on the connective tissue of the atherosclerotic plaque. No platelet deposition was seen on the central lipid core of the atherosclerotic plaque.To study the cause of increased platelet deposition on the atherosclerotic plaque, perfusion studies over cross sections of atherosclerotic coronary arteries were combined with immunohistochemical studies and inhibition studies using antibodies and specific inhibitors.
Methods
SpecimensPostmortem coronary arteries from 25 patients with different causes of death and fresh coronary arteries from 11 patients who were undergoing cardiac transplantation were obtained from the Depart...