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Task force #2—what is the pathologic basis for new atherosclerosis imaging techniques?

View larger version (65K): [in a new window]   Figure 1 Histopathology of plaque progression. Descriptions begin at top, from left to right. Intimal thickening is normal in all age groups and is characterized by smooth muscle cell accumulation within the intima. Intimal xanthoma corresponds to the fatty streak and denotes the accumulation of macrophages and lymphocytes within the intimal thickening lesion. Pathologic intimal thickening denotes the accumulation of extracellular lipid. Fibrous cap atheroma indicates the presence of a necrotic core under a fibrous cap, which may become thinned (thin-cap atheroma). This lesion may rupture, with exposure of thrombus to the lumen. The thrombus of a plaque erosion may overlie pathologic intimal thickening (left) or fibrous cap atheroma (right). Calcified nodule is a rare form of coronary thrombus. Acute rupture may progress to healing (healed plaque rupture) without luminal occlusion. EL = extracellular lipid; NC = necrotic core; FC = fibrous cap; Th = thrombus.

View larger version (56K): [in a new window]   Figure 2 Histomorphometric study demonstrating the percent cross-sectional luminal narrowing is positively correlated with the presence of any calcification. Burke AP, et al. Pathophysiology of Calcium Deposition in Coronary Arteries. HERZ 2001;26:239–44. (Copyright Urban & Vogel. Reproduced with permission.)

View larger version (25K): [in a new window]   Figure 3 Histomorphometric data demonstrate that, with increasing stenosis, necrotic core increases, especially in patients with acute myocardial infarction (3,4).

View larger version (14K): [in a new window]   Figure 4 Thin-cap atheromas are most frequent in patients dying with acute myocardial infarction (MI), followed by sudden coronary death (SCD) victims and incidental disease. Fibroatheromas and thin cap atheromas are not common in patients dying with plaque erosion (32).

View larger version (43K): [in a new window]   Figure 5 The distribution frequency of plaque ruptures (A,B) and thin-cap atheromas (C,D) by size of lipid core or lipid core as a percent of plaque area (x). The majority of plaque ruptures occur when lipid core area forms 25% to 50% of plaque area, or 1 to 3 mm2 lipid core area. In the case of thin-cap atheromas, the degree of cross-sectional area luminal narrowing and area of necrotic core is shifted to the left (lesser or smaller) as compared to plaque ruptures. Data derived from sudden death registry, Armed Forces Institute of Pathology (32).

View larger version (64K): [in a new window]   Figure 6 Relationship between plaque morphology and radiographic calcification, autopsy arteries. Reproduced with permission. Burke AP, et al. Pathophysiology of Calcium Deposition in Coronary Arteries. HERZ 2001;26:239–44. (Copyright Urban & Vogel. Reproduced with permission.)