Frequency and Distribution of Thin-Cap Fibroatheroma and Ruptured Plaques in Human Coronary ArteriesA 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.
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Figure 1 Longitudinal Sectioning of Coronary Tissue
This section was taken from a 78-year-old Caucasian man, 1 week status postmyocardial infarction, who died of a cerebrovascular accident. (A and B) Coronary arteries cut longitudinally at 20-mm increments to expose the vessel lumen. (C) Histology of a representative section visualized with the combined Verhoeff elastic-Gomori trichrome stain. Red box expanded in D displaying a thin-capped fibroatheroma characterized by a large lipid-rich necrotic core overlaid by a thin fibrous cap.
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Figure 2 Necrotic Core Size of Advanced Coronary Lesions
The mean necrotic core size of thick-capped fibroatheroma (ThCFA) was significantly lower than the necrotic core size of ruptured plaques in our study. Mean necrotic core size is reflected as a percentage of intimal area for ruptured plaque and fibrous cap atheroma. MCFA = medium-capped fibroatheroma; TCFA = thin-capped fibroatheroma.
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Figure 3 Frequency of Advanced Coronary Lesions
Frequencies of ruptured plaque and fibrous cap atheroma in all hearts studied are provided as a percentage of the total 3,639 coronary intervals of length 3 mm examined. Nonfibroatheromatous intervals accounted for the majority of coronary intervals, where TCFA and ruptured plaque together were observed in 2.7% of the coronary intervals. Abbreviations as in Figure 2.
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Figure 4 Focal Distribution of TCFA and Ruptured Plaque
Twenty of 50 hearts in our study (20 of 50) contained at least 1 thin-capped fibroatheroma (TCFA) or ruptured plaque. (A) A majority of these hearts (11 of 20) contained TCFA and ruptured plaque within 10 mm or less of coronary tissue. (B) In addition, a majority of the 20 hearts (12 of 20) contained TCFA and ruptured plaque within a single, contiguous 20-mm coronary segment. In 1 heart with widely distributed fibroatheromatous disease, 5 such 20-mm segments were required to contain all instances of TCFA and ruptured plaque.
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Figure 5 Spatial Distribution of Advanced Coronary Lesions
The number of hearts with ruptured plaque, thin-capped fibroatheroma (FA), and other FA, in millimeters from the coronary vessel ostium. (A) Left anterior descending artery (LAD). (B) Left circumflex artery (LCX). (C) Right coronary artery (RCA).
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Figure 6 Cumulative Frequency Distribution of TCFA and Ruptured Plaque
The cumulative frequency distribution curve of thin-capped fibroatheroma (TCFA) and ruptured plaque in each of 3 coronary arteries demonstrates a more diffuse distribution of these lesions in the RCA than in either branch of the left main coronary artery. Abbreviations as in Figure 5.
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