HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.04.086v1 50/10/940    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Cheruvu, P. K. Articles by Muller, J. E. Search for Related Content PubMed Articles by Cheruvu, P. K. Articles by Muller, J. E. Related Collections Related Article

CLINICAL RESEARCH: ATHEROMA MORPHOLOGY

Frequency and Distribution of Thin-Cap Fibroatheroma and Ruptured Plaques in Human Coronary Arteries

A Pathologic Study

Pavan K. Cheruvu, MSc^_*,1,_*, Aloke V. Finn, MD, Craig Gardner, PhD^,2, Jay Caplan, BS^,3, James Goldstein, MD^,4, Gregg W. Stone, MD^||,5, Renu Virmani, MD^¶,6 and James E. Muller, MD^,7

^_* Harvard Medical School, Boston, Massachusetts
Massachusetts General Hospital, Boston, Massachusetts
InfraReDx, Inc., Burlington, Massachusetts
William Beaumont Hospital, Royal Oak, Michigan
^|| Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
^¶ CV Path, Gaithersburg, Maryland.

Manuscript received December 22, 2006; revised manuscript received March 13, 2007, accepted April 3, 2007.

^_* Reprint requests and correspondence: Mr. Pavan K. Cheruvu, 104 Toxteth Street, #4, Brookline, Massachusetts 02446. (Email: pavan_cheruvu{at}hms.harvard.edu).

Objectives: Our purpose was to quantify the frequency and distribution of suspected vulnerable lesions, defined as thin-capped fibroatheroma (TCFA) and ruptured plaque, in human coronary artery autopsy specimens.

Background: Most acute coronary events and sudden death are believed to arise from rupture of a TCFA followed by thrombosis. Although there is general agreement that clinical events are usually caused by focal lesions, there is considerable debate over the relative importance of focal versus systemic factors in the pathogenesis of atherosclerosis.

Methods: We longitudinally sectioned coronary arteries from 50 whole hearts taken from patients (mean age 73 years, 64% men) dying of cardiovascular (n = 33), noncardiovascular (n = 13), and unknown (n = 4) causes. A total of 3,639 longitudinal segments of length 3 mm were sectioned from 148 arteries, accounting for 10.9 m of total tissue length. Specimens were classified on the basis of histology and computer-aided morphometry.

Results: Twenty-three TCFA and 19 ruptured plaques were found (mean ± SD: 0.46 ± 0.95 and 0.38 ± 0.70 per heart, respectively), and these lesions accounted for only 1.6% and 1.2%, respectively, of the total length of the coronary tree examined in patients dying of cardiovascular causes. The majority of TCFA and ruptured plaque localized in the proximal third of the major coronary arteries, and in 92% of cases these lesions clustered within 2 or fewer nonoverlapping 20-mm segments.

Conclusions: The suspected precursors of rupture-mediated thrombosis occur in a limited, focal distribution in the coronary arteries.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CV = cardiovascular   MCFA = medium-capped fibroatheroma   TCFA = thin-capped fibroatheroma   ThCFA = thick-capped fibroatheroma

Related Article

From Postmortem Characterization to the In Vivo Detection of Thin-Capped Fibroatheromas: The Missing Link Toward Percutaneous Treatment: What If Diogenes Would Have Found What He Was Looking For?

Patrick W. Serruys, Hector M. Garcia-Garcia, and Evelyn Regar
J. Am. Coll. Cardiol. 2007 50: 950-952. [Full Text] [PDF]

This article has been cited by other articles:

				P. Schoenhagen and E. M. Tuzcu Identifying patterns of atherosclerotic disease manifestation with coronary computed tomography. Impact on clinical management and outcome? Eur. Heart J., August 27, 2008; (2008) ehn392v1. [Full Text] [PDF]

				E. Thorp, D. Cui, D. M. Schrijvers, G. Kuriakose, and I. Tabas Mertk Receptor Mutation Reduces Efferocytosis Efficiency and Promotes Apoptotic Cell Accumulation and Plaque Necrosis in Atherosclerotic Lesions of Apoe-/- Mice Arterioscler. Thromb. Vasc. Biol., August 1, 2008; 28(8): 1421 - 1428. [Abstract] [Full Text] [PDF]

				G. S. Mintz Diabetic Coronary Artery Disease: How Little We Know and How Little Intravascular Ultrasound Has Taught Us J. Am. Coll. Cardiol., July 22, 2008; 52(4): 263 - 265. [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. Sanz, P. R. Moreno, and V. Fuster The year in atherothrombosis. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 944 - 955. [Full Text] [PDF]

				Y. S. Chatzizisis, M. Jonas, A. U. Coskun, R. Beigel, B. V. Stone, C. Maynard, R. G. Gerrity, W. Daley, C. Rogers, E. R. Edelman, et al. Prediction of the Localization of High-Risk Coronary Atherosclerotic Plaques on the Basis of Low Endothelial Shear Stress: An Intravascular Ultrasound and Histopathology Natural History Study Circulation, February 26, 2008; 117(8): 993 - 1002. [Abstract] [Full Text] [PDF]

				C. Yuan Carotid Atherosclerosis and Magnetic Resonance Imaging J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 58 - 60. [Full Text] [PDF]

				P. W. Serruys, H. M. Garcia-Garcia, and E. Regar From Postmortem Characterization to the In Vivo Detection of Thin-Capped Fibroatheromas: The Missing Link Toward Percutaneous Treatment: What If Diogenes Would Have Found What He Was Looking For? J. Am. Coll. Cardiol., September 4, 2007; 50(10): 950 - 952. [Full Text] [PDF]