Microemboli and Microvascular Obstruction in Acute Coronary Thrombosis and Sudden Coronary DeathRelation to Epicardial Plaque Histopathology
Robert S. Schwartz, MD*,*,
Allen Burke, MD ,
Andrew Farb, MD,
David Kaye, MD ,
John R. Lesser, MD*,
Timothy D. Henry, MD* and
Renu Virmani, MD
* Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota
CV Path Institute, Inc., Gaithersburg, Maryland
Baker Heart Institute, Melbourne, Australia
View larger version (157K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Coronary Artery Occlusion From Eroded Plaque
Epicardial coronary arteries with occlusive macroscopic thrombus (A to C) due to plaque erosion. Longitudinal sections (A, B, and C) and transaxial sections from a different vessel (D, E, and F) show the deep lipid core is not exposed. Immunostains of the thrombus for platelet (CD61, B and E) and fibrin (C and F) components reveal that the typical thrombus frequently is a mixed platelet-fibrin mixture. Images are from patients not included in the study, but illustrate typical coronary thrombus in sudden death due to plaque erosion. CD61 immunostain shows platelets within the thrombus are diffusely scattered throughout (slender arrow in B); junction between thrombus and the arterial plaque (thick arrow in B). The ‘cap’ of this thrombus is very fibrin-rich (arrow in C).
|
|
View larger version (119K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Microvascular Obstruction in Acute Coronary Occlusion
Microvascular obstruction is prominent, with a platelet thrombus predominating. Circumferential inflammatory cells surrounding the media of this arteriole are seen (A). Other examples of microvascular obstruction from thrombus show fibrin (B) and platelet components predominate (C). A transmission electron micrograph (D) shows a region of densely aggregated platelets.
|
|
View larger version (59K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Size Distribution of Microvascular Obstruction
Size distribution of affected microvessels is shown. A large majority (89%) of affected microvessels are <120 µm in diameter (dia). Of these occluded vessels ( 120 µm), an 89% majority are <80-µm diameter, with 46% between 40 and 80 µm and 39% <40 µm.
|
|
View larger version (105K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Microvascular Obstruction and Myocardial Necrosis Histopathology
Obstructed microvessels (small figure, left) result in myocardial necrosis. Contraction band necrosis (black arrows) and coagulative necrosis (white arrow) are frequent findings in myocardial segments distal to the obstructed microvasculature.
|
|
|
Interview