|
|
||||||||||
|
J Am Coll Cardiol, 2006; 47:13-18, doi:10.1016/j.jacc.2005.10.065 © 2006 by the American College of Cardiology Foundation |

* CVPath, International Registry of Pathology, Gaithersburg, Maryland
U.S. Food and Drug Administration, CDRH-ODE-DCD-ICDB, Rockville, Maryland
Manuscript received June 16, 2005; revised manuscript received October 10, 2005, accepted October 24, 2005.
* Reprint requests and correspondence: Dr. Renu Virmani, CVPath, International Registry of Pathology, 19 Firstfield Road, Gaithersburg, Maryland 20878. (Email: rvirmani{at}cvpath.org).
The majority of patients with acute coronary syndromes (ACS) present with unstable angina, acute myocardial infarction, and sudden coronary death. The most common cause of coronary thrombosis is plaque rupture followed by plaque erosion, whereas calcified nodule is infrequent. If advances in coronary disease are to occur, it is important to recognize the precursor lesion of ACS. Of the three types of coronary thrombosis, a precursor lesion for acute rupture has been postulated. The non-thrombosed lesion that most resembles the acute plaque rupture is the thin cap fibroatheroma (TCFA), which is characterized by a necrotic core with an overlying fibrous cap measuring <65 µm, containing rare smooth muscle cells but numerous macrophages. Thin cap fibroatheromas are most frequently observed in patients dying with acute myocardial infarction and least common in plaque erosion. They are most frequently observed in proximal coronary arteries, followed by mid and distal major coronary arteries. Vessels demonstrating TCFA do not usually show severe narrowing but show positive remodeling. In TCFAs the necrotic core length is approximately 2 to 17 mm (mean 8 mm) and the underlying cross-sectional area narrowing in over 75% of cases is <75% (diameter stenosis <50%). The area of the necrotic core in at least 75% of cases is
3 mm2. These lesions have lesser degree of calcification than plaque ruptures. Thin cap fibroatheromas are common in patients with high total cholesterol (TC) and high TC/high-density lipoprotein cholesterol ratio, in women >50 years, and in those patients with elevated high levels of high sensitivity C-reactive protein. It has only recently been recognized that their identification in living patients might help reduce the incidence of sudden coronary death.
| ||||||||
This article has been cited by other articles:
![]() |
T. Sawada, J. Shite, H. M. Garcia-Garcia, T. Shinke, S. Watanabe, H. Otake, D. Matsumoto, Y. Tanino, D. Ogasawara, H. Kawamori, et al. Feasibility of combined use of intravascular ultrasound radiofrequency data analysis and optical coherence tomography for detecting thin-cap fibroatheroma Eur. Heart J., May 1, 2008; 29(9): 1136 - 1146. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. A. Ambrose In Search of the "vulnerable plaque": can it be localized and will focal regional therapy ever be an option for cardiac prevention? J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1539 - 1542. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. W. Han, K. Shimada, W. Ma-Krupa, T. L. Johnson, R. M. Nerem, J. J. Goronzy, and C. M. Weyand Vessel Wall-Embedded Dendritic Cells Induce T-Cell Autoreactivity and Initiate Vascular Inflammation Circ. Res., March 14, 2008; 102(5): 546 - 553. [Abstract] [Full Text] [PDF] |
||||
![]() |
I. Gottlieb and J. A.C. Lima Screening High-Risk Patients With Computed Tomography Angiography Circulation, March 11, 2008; 117(10): 1318 - 1332. [Full Text] [PDF] |
||||
![]() |
F. Johansson, F. Kramer, S. Barnhart, J. E. Kanter, T. Vaisar, R. D. Merrill, L. Geng, K. Oka, L. Chan, A. Chait, et al. Type 1 diabetes promotes disruption of advanced atherosclerotic lesions in LDL receptor-deficient mice PNAS, February 12, 2008; 105(6): 2082 - 2087. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Svilaas, P. J. Vlaar, I. C. van der Horst, G. F.H. Diercks, B. J.G.L. de Smet, A. F.M. van den Heuvel, R. L. Anthonio, G. A. Jessurun, E.-S. Tan, A. J.H. Suurmeijer, et al. Thrombus Aspiration during Primary Percutaneous Coronary Intervention N. Engl. J. Med., February 7, 2008; 358(6): 557 - 567. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Kubo, T. Imanishi, S. Takarada, A. Kuroi, S. Ueno, T. Yamano, T. Tanimoto, Y. Matsuo, T. Masho, H. Kitabata, et al. Implication of Plaque Color Classification for Assessing Plaque Vulnerability: A Coronary Angioscopy and Optical Coherence Tomography Investigation J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 74 - 80. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Williams, L. J. Shaw, P. Raggi, D. Morris, V. Vaccarino, S. T. Liu, S. R. Weinstein, T. P. Mosler, P. H. Tseng, F. R. Flores, et al. Prognostic Value of Number and Site of Calcified Coronary Lesions Compared With the Total Score J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 61 - 69. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Aikawa, M. Nahrendorf, J.-L. Figueiredo, F. K. Swirski, T. Shtatland, R. H. Kohler, F. A. Jaffer, M. Aikawa, and R. Weissleder Osteogenesis Associates With Inflammation in Early-Stage Atherosclerosis Evaluated by Molecular Imaging In Vivo Circulation, December 11, 2007; 116(24): 2841 - 2850. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. M. Knapp, J. E. Ramsey, S.-X. Wang, A. R. Strauch, and R. J. Kelm Jr. Structure-Function Analysis of Mouse Pur II: CONFORMATION ALTERING MUTATIONS DISRUPT SINGLE-STRANDED DNA AND PROTEIN INTERACTIONS CRUCIAL TO SMOOTH MUSCLE {alpha}-ACTIN GENE REPRESSION J. Biol. Chem., December 7, 2007; 282(49): 35899 - 35909. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. V. Finn, G. Nakazawa, J. Narula, and R. Virmani Culprit Plaque in Myocardial Infarction: Going Beyond Angiography J. Am. Coll. Cardiol., December 4, 2007; 50(23): 2204 - 2206. [Full Text] [PDF] |
||||
![]() |
C. L. Welch, Y. Sun, B. J. Arey, V. Lemaitre, N. Sharma, M. Ishibashi, S. Sayers, R. Li, A. Gorelik, N. Pleskac, et al. Spontaneous Atherothrombosis and Medial Degradation in Apoe / , Npc1 / Mice Circulation, November 20, 2007; 116(21): 2444 - 2452. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. G. Spagnoli, E. Bonanno, G. Sangiorgi, and A. Mauriello Role of Inflammation in Atherosclerosis J. Nucl. Med., November 1, 2007; 48(11): 1800 - 1815. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Horiguchi, C. Fujioka, M. Kiguchi, Y. Shen, C. E. Althoff, H. Yamamoto, and K. Ito Soft and Intermediate Plaques in Coronary Arteries: How Accurately Can We Measure CT Attenuation Using 64-MDCT? Am. J. Roentgenol., October 1, 2007; 189(4): 981 - 988. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. G. Dickhout, S. M. Colgan, S. Lhotak, and R. C. Austin Increased Endoplasmic Reticulum Stress in Atherosclerotic Plaques Associated With Acute Coronary Syndrome: A Balancing Act Between Plaque Stability and Rupture Circulation, September 11, 2007; 116(11): 1214 - 1216. [Full Text] [PDF] |
||||
![]() |
P. K. Cheruvu, A. V. Finn, C. Gardner, J. Caplan, J. Goldstein, G. W. Stone, R. Virmani, and J. E. Muller Frequency and Distribution of Thin-Cap Fibroatheroma and Ruptured Plaques in Human Coronary Arteries: A Pathologic Study J. Am. Coll. Cardiol., September 4, 2007; 50(10): 940 - 949. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. Nakazawa, A. V Finn, and R. Virmani Virtual histology: does it add anything? Heart, August 1, 2007; 93(8): 897 - 898. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Motoyama, T. Kondo, M. Sarai, A. Sugiura, H. Harigaya, T. Sato, K. Inoue, M. Okumura, J. Ishii, H. Anno, et al. Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes J. Am. Coll. Cardiol., July 24, 2007; 50(4): 319 - 326. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. A. Kaufmann, J. M. Sanders, C. Davis, A. Xie, P. Aldred, I. J. Sarembock, and J. R. Lindner Molecular Imaging of Inflammation in Atherosclerosis With Targeted Ultrasound Detection of Vascular Cell Adhesion Molecule-1 Circulation, July 17, 2007; 116(3): 276 - 284. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. A. Rodriguez-Feo, W. E. Hellings, B. A.N. Verhoeven, F. L. Moll, D. P.V. de Kleijn, J. Prendergast, Y. Gao, Y. van der Graaf, G. Tellides, W. C. Sessa, et al. Low Levels of Nogo-B in Human Carotid Atherosclerotic Plaques Are Associated With an Atheromatous Phenotype, Restenosis, and Stenosis Severity Arterioscler. Thromb. Vasc. Biol., June 1, 2007; 27(6): 1354 - 1360. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Lerman, D. R. Holmes, J. Herrmann, and B. J. Gersh Microcirculatory dysfunction in ST-elevation myocardial infarction: cause, consequence, or both? Eur. Heart J., April 1, 2007; 28(7): 788 - 797. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. E. Kanter, F. Johansson, R. C. LeBoeuf, and K. E. Bornfeldt Do Glucose and Lipids Exert Independent Effects on Atherosclerotic Lesion Initiation or Progression to Advanced Plaques? Circ. Res., March 30, 2007; 100(6): 769 - 781. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. G. Brown and X.-Q. Zhao Is Intravascular Ultrasound the Gold Standard Surrogate for Clinically Relevant Atherosclerosis Progression? J. Am. Coll. Cardiol., March 6, 2007; 49(9): 933 - 938. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. C. Thomas, G. B. Sala-Newby, Y. Ismail, J. L. Johnson, G. Pasterkamp, and A. C. Newby Genomics of Foam Cells and Nonfoamy Macrophages From Rabbits Identifies Arginase-I as a Differential Regulator of Nitric Oxide Production Arterioscler. Thromb. Vasc. Biol., March 1, 2007; 27(3): 571 - 577. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Tsimikas, M. Aikawa, F. J. Miller Jr, E. R. Miller, M. Torzewski, S. R. Lentz, C. Bergmark, D. D. Heistad, P. Libby, and J. L. Witztum Increased Plasma Oxidized Phospholipid:Apolipoprotein B-100 Ratio With Concomitant Depletion of Oxidized Phospholipids From Atherosclerotic Lesions After Dietary Lipid-Lowering: A Potential Biomarker of Early Atherosclerosis Regression Arterioscler. Thromb. Vasc. Biol., January 1, 2007; 27(1): 175 - 181. [Abstract] [Full Text] [PDF] |
||||
![]() |
J.-F. Surmely, K. Nasu, H. Fujita, M. Terashima, T. Matsubara, E. Tsuchikane, M. Ehara, Y. Kinoshita, Q. X. Zheng, N. Tanaka, et al. Coronary plaque composition of culprit/target lesions according to the clinical presentation: a virtual histology intravascular ultrasound analysis Eur. Heart J., December 2, 2006; 27(24): 2939 - 2944. [Abstract] [Full Text] [PDF] |
||||
![]() |
F. D. Kolodgie, A. P. Burke, K. S. Skorija, E. Ladich, R. Kutys, A. T. Makuria, and R. Virmani Lipoprotein-Associated Phospholipase A2 Protein Expression in the Natural Progression of Human Coronary Atherosclerosis Arterioscler. Thromb. Vasc. Biol., November 1, 2006; 26(11): 2523 - 2529. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Libby and P. M. Ridker Inflammation and Atherothrombosis: From Population Biology and Bench Research to Clinical Practice J. Am. Coll. Cardiol., October 27, 2006; 48(9_Suppl_A): A33 - A46. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Ryan and D. J. Cohen Are Drug-Eluting Stents Cost-Effective?: It Depends on Whom You Ask Circulation, October 17, 2006; 114(16): 1736 - 1744. [Full Text] [PDF] |
||||
![]() |
R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndromes J. Am. Coll. Cardiol., July 18, 2006; 48(2): 386 - 395. [Full Text] [PDF] |
||||
![]() |
J. E. Muller, A. Tawakol, S. Kathiresan, and J. Narula New opportunities for identification and reduction of coronary risk treatment of vulnerable patients, arteries, and plaques. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C2 - C6. [Abstract] [Full Text] [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |