Intraplaque hemorrhage and progression of coronary atheroma

Kolodgie, Frank D.; Gold, H.K.; Burke, Allen

doi:10.1016/j.accreview.2003.12.007

Cited by 231 publications

(342 citation statements)

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“…To assess the stress change due to the presence of PH, PH was replaced by lipid pool to indicate a baseline state, and a stress calculation was done. This is in accordance with Kolodgie et al's assessment that the extent of intraplaque haemorrhage corresponds positively to the size of the necrotic core [17]. To assess the effect of PH by varying its age, the simulations were repeated by using material properties of chronic haemorrhage.…”

Section: Mesh Generation Computational Models and Solution Methodsmentioning

confidence: 84%

Impact of plaque haemorrhage and its age on structural stresses in atherosclerotic plaques of patients with carotid artery disease: an MR imaging-based finite element simulation study

Sadat

Zhang

Young

et al. 2010

Int J Cardiovasc Imaging

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Plaque haemorrhage (PH) in atherosclerotic plaques is associated with recurrent thromboembolic ischaemic events. The healing process predominantly involves the repair of the plaque rupture site and the replacement of fresh PH with chronic PH, which is either reabsorbed or replaced by fibrous tissue. The extent to which the presence of PH, and its type i.e. fresh or chronic, affects plaque stability remains unexplored. Finite element analysis (FEA)-based biomechanical stress simulations can provide quantification of the percentage contribution of PH and its types to the biomechanical stresses of plaques, thereby providing information about its role in plaque stability. Fifty-two patients with atherosclerotic carotid disease underwent high resolution magnetic resonance (MR) imaging of their carotid arteries in a 1.5 Tesla MR system. Twenty-three patients had MR-identifiable PH and were selected. Only those images of these patients were used for simulations, which had evidence of PH. Manual segmentation of plaque components, such as lipid pool, fibrous tissue, calcium and PH, was done using carotid MR images. Plaque components and vessel wall were modelled as isotropic, incompressible hyperelastic materials with non-linear properties undergoing deformation under patient-specific blood pressure loading. Two dimensional structure-only FEA was used for quantification of maximum critical stress (M-CStress) of plaques. The median M-CStress of symptomatic patients with fresh PH was 159 kPa (IQR: 114-253). Because PH usually occurs within the lipid pool, when the simulation was repeated with lipid pool replacing fresh PH to simulate the pre-rupture plaque state, M-CStress was reduced by 26% [118 kPa (IQR: 79-189) (P=0.001)]. When fresh PH was replaced with chronic PH it resulted in a 30% reduction in the M-CStress [118 kP (IQR: 79-189), (P=0.001)]. PH affects stresses within atheroma to various degrees depending on its type, thereby influencing plaque stability to a different extent, with fresh PH significantly increasing the biomechanical stresses. Plaque component-dependent stress analysis has the potential of identifying the critical nature of various plaque components.

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Section: Mesh Generation Computational Models and Solution Methodsmentioning

confidence: 84%

Impact of plaque haemorrhage and its age on structural stresses in atherosclerotic plaques of patients with carotid artery disease: an MR imaging-based finite element simulation study

Sadat

Zhang

Young

et al. 2010

Int J Cardiovasc Imaging

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“…L lumen, M media. Scale bar 50 m of intraplaque haemorrhage (Kolodgie et al 2003). Although these results have to be interpreted carefully, increased expression of ObR and VEGFR-1 in the intima of neovascularised regions using immunohistochemical analysis has been reported earlier by others (Park et al 2001).…”

Section: Discussionmentioning

confidence: 78%

Expression of the leptin receptor in different types of vascular lesions

Schroeter

Schneiderman

Schumann

et al. 2007

Histochem Cell Biol

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Clinical and experimental evidence suggests that the adipokine leptin may be important for the development of cardiovascular complications associated with obesity, possibly through interaction with its receptor on vascular cells. In the present study, we systematically analysed expression of the leptin receptor in normal and diseased vascular specimens using immunohistochemistry, immunofluorescence and quantitative real time-PCR. In particular, human atherosclerotic plaques as well as experimental vascular lesions induced in hypercholesterolemic mice and minipigs, respectively, were examined. Our results demonstrate the presence of the leptin receptor in normal vessel wall segments as well as neointimal or atherosclerotic lesions. In the latter, ObR expressing cells were predominantly localised on the luminal border and within the subintima, and coexpression of von Willebrand factor, VEGF receptor-2 or VE cadherin identified them as endothelial cells. Moreover, CD14-positive monocytes/macrophages were strongly positive for the leptin receptor. In contrast, only few ObR-expressing smooth muscle cells could be detected in human atherosclerotic plaques. The findings of the present study thus support a possible action of leptin on the cardiovascular system by demonstrating expression of the leptin receptor in different types of vascular lesions.

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“…Second, intraplaque hemorrhage has been associated with a more rapid growth of the lipidrich necrotic core and accelerated progression in plaque burden that seem to induce luminal narrowing regardless of initial stenotic severity [17]. Several lines of evidence from pathohistological studies have suggested that the increased density of microvessels, as well as increased erythrocyte extravasation and erythrophagocytosis by macrophages are associated with intraplaque hemorrhage [18,19]. Our present results revealed that the frequency of TCFA, intimal vasculature, and macrophage accumulation was the highest in patients with UAP of classes II + III, regardless of the extent of rupture or thrombus.…”

Section: Discussionmentioning

confidence: 98%

Coronary plaque rupture with subsequent thrombosis typifies the culprit lesion of non-ST-segment-elevation myocardial infarction, not unstable angina: non-ST-segment-elevation acute coronary syndrome study

et al. 2016

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Recently, unstable angina pectoris (UAP) and non-ST-segment-elevation myocardial infarction (NSTEMI) have been considered together because they exhibit indistinguishable clinical and electrocardiogram features, and constitute non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). However, no optical coherence tomography (OCT) studies have reported the association between vulnerable plaque morphology and clinical characteristics in NSTE-ACS patients based on assessment of clinical symptoms and myocardial necrosis. The aim of this study was to investigate the differences in clinical characteristics and plaque morphology assessed by OCT between patients with UAP and NSTEMI. Preinterventional OCT images of 84 NSTE-ACS patients were studied, 19 with NSTEMI and 65 with UAP, according to levels of high-sensitivity troponin T. The frequency of plaque rupture and thrombus in patients with NSTEMI was higher than in UAP patients with either class I or II + III (rupture: NSTEMI, 68 %; UAP classes II + III, 30 %; UAP class I, 19 %, thrombus: NSTEMI, 73 %; UAP classes II + III, 22 %; UAP class I, 14 %). In NSTEMI patients, the frequency of occurrence of both thrombus and rupture was the highest. Conversely, patients with UAP class I or those with UAP classes II + III most frequently had no thrombus and rupture, and the frequencies of the presence of thrombus were only 14 and 22 %, respectively. Multivariate analysis revealed that thrombus and plaque rupture were independently associated with NSTEMI. This study demonstrates that the morphological features of culprit lesions could be related to clinical severity in NSTE-ACS patients.

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Intraplaque hemorrhage and progression of coronary atheroma

Cited by 231 publications

References 0 publications

Impact of plaque haemorrhage and its age on structural stresses in atherosclerotic plaques of patients with carotid artery disease: an MR imaging-based finite element simulation study

Impact of plaque haemorrhage and its age on structural stresses in atherosclerotic plaques of patients with carotid artery disease: an MR imaging-based finite element simulation study

Expression of the leptin receptor in different types of vascular lesions

Coronary plaque rupture with subsequent thrombosis typifies the culprit lesion of non-ST-segment-elevation myocardial infarction, not unstable angina: non-ST-segment-elevation acute coronary syndrome study

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