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Plaque inflammation in restenotic coronary lesions of patients with stable or unstable angina

Jan J. Piek, MD^* , Allard C. Van Der Wal, MD, Martijn Meuwissen, MD^* , Karel T. Koch, MD^* , Steven A. J. Chamuleau, MD^* , Peter Teeling, RT, Chris M. Van Der Loos, PhD and Anton E. Becker, MD, FACC

^* Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

View larger version (101K): [in a new window]   Figure 1 Part of an atherectomy specimen derived from a restenotic culprit coronary lesion of a patient with unstable angina, H&E (haematoxylin & eosin) stained frozen section. a: overview, boxed areas are shown in b and c. b: detail of hypercellular myxoid area showing stellate-shaped cells amidst abundant extracellular matrix. c. Detail of atheromatous tissue showing a rim of mononuclear cells near to atheroma (upper part). Magnification 22.5x, reduced by 70% (a) and 172.5x, reduced by 70% (b,c).

View larger version (105K): [in a new window]   Figure 2 Serial section adjacent to Figure 1, immunostained with anti-alpha-SMC actin. b: detail of myxoid tissue showing a large amount of young stellate SMCs. c: detail of atheromatous tissue containing only a few SMCs. Magnification 22.5x (a) and 172.5x (b,c). SMC = smooth muscle cell.

View larger version (102K): [in a new window]   Figure 3 Serial section adjacent to Figure 1, immunostained with anti-CD 68. Figure 3a: overview. b: detail of myxoid tissue showing low numbers of diffusely spread small MACs. c: detail of atheromatous tissue showing rim of closely packed immunostained MACs. Magnification 22.5x, reduced by 70% (a) and 172.5x, reduced by 70% (b,c). MAC(s) = macrophage(s).

View larger version (21K): [in a new window]   Figure 4 Percentages of immunostained smooth muscle cell areas and macrophage areas and number of T-lymphocytes/mm2 in restenotic coronary lesions underlying stable angina (CCS 1–3) and unstable angina (Braunwald I–III). Data are expressed as mean ± SD. CCS = Canadian Cardiovascular Society. Open bar = stable angina; closed bar = unstable angina.