CLINICAL STUDIES
Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox
Gerard Pasterkamp, MD, PhD*  ||,
Arjan H. Schoneveld, MSc* ||,
Allard C. van der Wal, MD, PhD ,
Christian C. Haudenschild, MD, PhD ,
Ruud J. G. Clarijs, MD*,
Anton E. Becker, MD, PhD,
Berend Hillen, MD, PhD and
Cornelius Borst, MD, PhD, FACC*
* Cardiology, Utrecht University Hospital, Utrecht, the Netherlands
Functional Anatomy, Utrecht University Hospital, Utrecht, the Netherlands
Department of Cardiovascular Pathology, Academic Medical Center, Amersterdam, the Netherlands
Department of Pathology, Red Cross Holland Laboratory, Rockville, Maryland, USA
|| Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Manuscript received November 18, 1997;
revised manuscript received May 6, 1998,
accepted May 14, 1998.
Address for correspondence: Dr. G. Pasterkamp, Experimental Cardiology Laboratory, Utrecht University Hospital, Room G02-523, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
g.pasterkamp{at}hli.azu.nl
Objective. To relate local arterial geometry with markers that are thought to be related to plaque rupture.
Background. Plaque rupture often occurs at sites with minor luminal stenosis and has retrospectively been characterized by colocalization of inflammatory cells. Recent studies have demonstrated that luminal narrowing is related with the mode of atherosclerotic arterial remodeling.
Methods. We obtained 1,521 cross section slices at regular intervals from 50 atherosclerotic femoral arteries. Per artery, the slices with the largest and smallest lumen area, vessel area and plaque area were selected for staining on the presence of macrophages (CD68), T-lymphocytes (CD45RO), smooth muscle cells (alpha-actin) and collagen.
Results. Inflammation of the cap or shoulder of the plaque was observed in 33% of all cross sections. Significantly more CD68 and CD45RO positive cells, more atheroma, less collagen and less alpha-actin positive staining was observed in cross sections with the largest plaque area and largest vessel area vs. cross sections with the smallest plaque area and smallest vessel area, respectively. No difference in the number of inflammatory cells was observed between cross sections with the largest and smallest lumen area.
Conclusion. Intraindividually, pathohistologic markers previously reported to be related to plaque vulnerability were associated with a larger plaque area and vessel area. In addition, inflammation of the cap and shoulder of the plaque was a common finding in the atherosclerotic femoral artery.
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P. Schoenhagen, K. M. Ziada, D. G. Vince, S. E. Nissen, and E. M. Tuzcu
Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis
J. Am. Coll. Cardiol.,
August 1, 2001;
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C. von Birgelen, W. Klinkhart, G. S. Mintz, A. Papatheodorou, J.o. Herrmann, D. Baumgart, M. Haude, H. Wieneke, J. Ge, and R. Erbel
Plaque distribution and vascular remodeling of ruptured and nonruptured coronary plaques in the same vessel: an intravascular ultrasound study in vivo
J. Am. Coll. Cardiol.,
June 1, 2001;
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[Abstract]
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G. S. Mintz, S. E. Nissen, W. D. Anderson, S. R. Bailey, R. Erbel, P. J. Fitzgerald, F. J. Pinto, K. Rosenfield, R. J. Siegel, E. M. Tuzcu, et al.
American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (ivus): A report of the american college of cardiology task force on clinical expert consensus documents developed in collaboration with the european society of cardiology endorsed by the society of cardiac angiography and interventions
J. Am. Coll. Cardiol.,
April 1, 2001;
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H. Okura, Y. Morino, A. Oshima, M. Hayase, M. R. Ward, J. J. Popma, R. E. Kuntz, H. N. Bonneau, P. G. Yock, and P. J. Fitzgerald
Preintervention arterial remodeling affects clinical outcome following stenting: an intravascular ultrasound study
J. Am. Coll. Cardiol.,
March 15, 2001;
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[Abstract]
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G. Pasterkamp, A. Vink, C. Borst, T. C. Wascher, A. deCampo, I. Schmoelzer, J. A. Goldstein, C. Grines, and W. W. O'Neill
Multiple Complex Coronary Plaques in Patients with Acute Myocardial Infarction
N. Engl. J. Med.,
February 15, 2001;
344(7):
527 - 528.
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P. Wexberg, M. Gyongyosi, W. Sperker, K. Kiss, P. Yang, A. Hassan, G. Pasterkamp, and D. Glogar
Pre-existing arterial remodeling is associated with in-hospital and late adverse cardiac events after coronary interventions in patients with stable angina pectoris
J. Am. Coll. Cardiol.,
November 15, 2000;
36(6):
1860 - 1869.
[Abstract]
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C von Birgelen, W Klinkhart, G S Mintz, H Wieneke, D Baumgart, M Haude, T Bartel, S Sack, J Ge, and R Erbel
Size of emptied plaque cavity following spontaneous rupture is related to coronary dimensions, not to the degree of lumen narrowing. A study with intravascular ultrasound in vivo
Heart,
November 1, 2000;
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483 - 488.
[Abstract]
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M. R. Ward, G. Pasterkamp, A. C. Yeung, and C. Borst
Arterial Remodeling : Mechanisms and Clinical Implications
Circulation,
September 5, 2000;
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A Jeremias, C Spies, N A Herity, E Pomerantsev, P G Yock, P J Fitzgerald, and A C Yeung
Coronary artery compliance and adaptive vessel remodelling in patients with stable and unstable coronary artery disease
Heart,
September 1, 2000;
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314 - 319.
[Abstract]
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G. Pasterkamp, E. Falk, H. Woutman, and C. Borst
Techniques characterizing the coronary atherosclerotic plaque: influence on clinical decision making?
J. Am. Coll. Cardiol.,
July 1, 2000;
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[Abstract]
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G. Pasterkamp, D. P.V de Kleijn, and C. Borst
Arterial remodeling in atherosclerosis, restenosis and after alteration of blood flow: potential mechanisms and clinical implications
Cardiovasc Res,
March 1, 2000;
45(4):
843 - 852.
[Abstract]
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P. Schoenhagen, K. M. Ziada, S. R. Kapadia, T. D. Crowe, S. E. Nissen, and E. M. Tuzcu
Extent and Direction of Arterial Remodeling in Stable Versus Unstable Coronary Syndromes : An Intravascular Ultrasound Study
Circulation,
February 15, 2000;
101(6):
598 - 603.
[Abstract]
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M. Yamagishi, M. Terashima, K. Awano, M. Kijima, S. Nakatani, S. Daikoku, K. Ito, Y. Yasumura, and K. Miyatake
Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome
J. Am. Coll. Cardiol.,
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[Abstract]
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P C Smits, G Pasterkamp, M A Q. van Ufford, F D Eefting, P R Stella, P P T de Jaegere, and C Borst
Coronary artery disease: arterial remodelling and clinical presentation
Heart,
October 1, 1999;
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[Abstract]
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A. C. van der Wal and A. E. Becker
Atherosclerotic plaque rupture - pathologic basis of plaque stability and instability
Cardiovasc Res,
February 1, 1999;
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P. C Smits, G. Pasterkamp, P. P.T de Jaegere, P. J de Feyter, and C. Borst
Angioscopic complex lesions are predominantly compensatory enlarged: an angioscopy and intracoronary ultrasound study
Cardiovasc Res,
February 1, 1999;
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458 - 464.
[Abstract]
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G. Pasterkamp, A. H. Schoneveld, A. C. van der Wal, D.-J. Hijnen, W. J. A. van Wolveren, S. Plomp, H. L. J. M. Teepen, and C. Borst
Inflammation of the Atherosclerotic Cap and Shoulder of the Plaque Is a Common and Locally Observed Feature in Unruptured Plaques of Femoral and Coronary Arteries
Arterioscler Thromb Vasc Biol,
January 1, 1999;
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[Abstract]
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A. M. Varnava, P. G. Mills, and M. J. Davies
Relationship Between Coronary Artery Remodeling and Plaque Vulnerability
Circulation,
February 26, 2002;
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[Abstract]
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