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J Am Coll Cardiol, 2006; 47:13-18, doi:10.1016/j.jacc.2005.10.065
© 2006 by the American College of Cardiology Foundation
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Pathology of the Vulnerable Plaque

Renu Virmani, MD*,*, Allen P. Burke, MD*, Andrew Farb, MD{dagger} and Frank D. Kolodgie, PhD*

* CVPath, International Registry of Pathology, Gaithersburg, Maryland
{dagger} U.S. Food and Drug Administration, CDRH-ODE-DCD-ICDB, Rockville, Maryland

Manuscript received June 16, 2005; revised manuscript received October 10, 2005, accepted October 24, 2005.

* Reprint requests and correspondence: Dr. Renu Virmani, CVPath, International Registry of Pathology, 19 Firstfield Road, Gaithersburg, Maryland 20878. (Email: rvirmani{at}cvpath.org).


    Abstract
 Top
 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
The majority of patients with acute coronary syndromes (ACS) present with unstable angina, acute myocardial infarction, and sudden coronary death. The most common cause of coronary thrombosis is plaque rupture followed by plaque erosion, whereas calcified nodule is infrequent. If advances in coronary disease are to occur, it is important to recognize the precursor lesion of ACS. Of the three types of coronary thrombosis, a precursor lesion for acute rupture has been postulated. The non-thrombosed lesion that most resembles the acute plaque rupture is the thin cap fibroatheroma (TCFA), which is characterized by a necrotic core with an overlying fibrous cap measuring <65 µm, containing rare smooth muscle cells but numerous macrophages. Thin cap fibroatheromas are most frequently observed in patients dying with acute myocardial infarction and least common in plaque erosion. They are most frequently observed in proximal coronary arteries, followed by mid and distal major coronary arteries. Vessels demonstrating TCFA do not usually show severe narrowing but show positive remodeling. In TCFAs the necrotic core length is approximately 2 to 17 mm (mean 8 mm) and the underlying cross-sectional area narrowing in over 75% of cases is <75% (diameter stenosis <50%). The area of the necrotic core in at least 75% of cases is ≤3 mm2. These lesions have lesser degree of calcification than plaque ruptures. Thin cap fibroatheromas are common in patients with high total cholesterol (TC) and high TC/high-density lipoprotein cholesterol ratio, in women >50 years, and in those patients with elevated high levels of high sensitivity C-reactive protein. It has only recently been recognized that their identification in living patients might help reduce the incidence of sudden coronary death.

Abbreviations and Acronyms
  ACS = acute coronary syndromes
  CRP = C-reactive protein
  HDL = high-density lipoprotein
  MPO = myeloperoxidase
  TC = total cholesterol
  TCFA = thin cap fibroatheroma


Patients with acute coronary syndromes (ACS) present with unstable angina, acute myocardial infarction, and sudden coronary death. Most of the ACS are thought to be the result of sudden luminal thrombosis (1–5). Luminal thrombosis occurs from three different pathologies: plaque rupture, erosion, and calcified nodules. Plaque rupture is defined as a lesion consisting of a necrotic core with an overlying thin ruptured fibrous cap that leads to luminal thrombosis because of contact of platelets with a highly thrombogenic necrotic core. Plaque erosion shows a luminal thrombus with an underlying base rich in proteoglycans and smooth muscle cells with minimal inflammation. Most erosion lesions are devoid of a necrotic core, but when present, the core does not communicate with the lumen because of a thick fibrous cap. The least common of all lesions is the calcified nodule. The calcified nodule shows an underlying calcified plate with superimposed bony nodules that result in discontinuity of the fibrous cap and is devoid of endothelial cells with overlying luminal thrombus.

We have examined over 400 cases of sudden death that have been published in the last 15 years highlighting differences in type of thrombi; influence of race, age, and gender; and the role of risk factors on plaque morphologies (1–12). The frequency of thrombi in sudden death is 60% with underlying etiology in 55% to 60% plaque rupture, in 30% to 35% plaque erosion, and in 2% to 7% calcified nodule. In the case of myocardial infarction, an autopsy study has shown that only 20% to 25% of acute myocardial infarcts occurring in hospitalized patients are due to plaque erosion (13). In both acute myocardial infarction and sudden death, plaque erosion occurs primarily in patients under the age of 50 years and represents the majority of acute coronary thrombi in premenopausal women. In women older than 50 years, 80% of coronary thrombi occur from plaque rupture; when they occur in women younger than 50 years, there is a strong association with hyperlipidemia. Plaque ruptures occur in men at all ages, but, as is the case with all types of thrombosis, their relative incidence in sudden coronary death decreases with advancing age. In 40% of sudden coronary death patients, no acute thrombi are observed; however, healed infarction and total occlusions are observed in the vast majority with only 15% dying of severe coronary narrowing in the presence or absence of cardiomegaly.


    Plaque rupture as the basis of ACS
 Top
 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
It has been postulated that thin cap fibroatheroma (TCFA), which resemble the plaque rupture in morphology, are the precursor lesion of plaque rupture. A necrotic core characterizes plaque rupture with an overlying thin-ruptured cap infiltrated by macrophages (Fig. 1). Smooth muscle cells within the cap are absent or few. The thickness of the fibrous cap near the rupture site measures 23 ± 19 µm, with 95% of the caps measuring <65 µm (1). It has been observed that some plaques at other sites in the coronary tree resemble the rupture plaque but lack a luminal thrombus: these lesions have been designated as TCFA or vulnerable plaques (4). The term vulnerable plaque should be reserved for plaques that resemble all three causes of luminal thrombosis, and these morphologies include TCFA, pathologic intimal thickening, thick cap fibroatheroma, and calcified plaque with luminal calcified nodules.


Figure 1
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Figure 1 Coronary plaque rupture. (A) Low-power view of a circumferential coronary plaque with fibrous cap rupture. Note the large necrotic core with numerous cholesterol clefts. There is a focal disruption of a thin fibrous cap (arrow) with an occlusive luminal thrombus (Movat Pentachrome, x20). (B) High-power view of the rupture site showing fibrous cap disruption (arrows); the thrombus shows communication with the underlying necrotic core (Movat Pentachrome, x400).

 
The TCFAs differ from ruptured plaques (Table 1, Fig. 2), by having a smaller necrotic core (statistically different from ruptured plaques), less macrophage infiltration of the fibrous cap, and less calcification. We have quantitated, in cross sections of coronary arteries with various types of plaques, the size of the necrotic core, the proportion of the lesion composed of cholesterol clefts, the percent macrophage infiltration of the fibrous cap, the number of vasa vasorum within the atherosclerotic plaque, and the number of hemosiderin-laden macrophages (Table 2). The numbers of cholesterol clefts in the necrotic core, vasa vasorum, and hemosiderin-laden macrophages were significantly greater in the ruptured plaques than in erosion or stable plaques with >75% cross-sectional luminal narrowing. Significant differences between rupture and TCFAs were only seen for necrotic core size, macrophages, and hemosiderin infiltration. Plaque hemorrhages are more common at other sites of the coronary tree in cases with plaque ruptures than in hearts from patients dying with severe coronary disease without acute ruptures. The mean number of hemorrhages in the coronary tree of patients with plaque rupture was 2.5 ± 1.3 versus none in erosion and 0.05 ± 0.6 in stable plaques (4). Evidence of prior hemorrhage in TCFA, when analyzed by glycophorin A staining, is significantly greater than in early or late fibroatheromas and correlates with both the necrotic core size and extent of macrophage infiltration.


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Table 1. Morphologic Characteristics of Plaque Rupture and TCFA
 

Figure 2
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Figure 2 Thin-cap fibroatheroma. (A) Low-power view of an eccentric coronary plaque showing a thin fibrous cap overlying a relatively large necrotic core; the vessel was injected with barium (Movat Pentachrome, x20). (B) Immunohistochemical staining reveals numerous CD68-positive macrophages within the fibrous cap (rose-red reaction product, x400). (C) Shows a cellular-rich thin fibrous cap with cholesterol clefts. (D) Staining for alpha-actin positive smooth muscle cells within the fibrous cap was virtually negative (x400). (Reproduced with permission from Kolodgie FD, Virmani R, Burke AP, Farb A, et al. Pathologic assessment of the vulnerable human coronary plaque. Heart 2004;90:1385–91.)

 

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Table 2. Comparison of the Size of the Necrotic Core, Number of Cholesterol Clefts, Macrophage Infiltration, Number of Vasa Vasorum, and Hemosiderin-Laden Macrophages in Plaque Rupture, TCFAs, Erosion, and Stable Plaques
 

    Location, length, and percent luminal narrowing of the TCFA
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 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
In a detailed morphometric analysis of ruptured plaques, 80% of necrotic cores were larger than 1.0 mm2, and in nearly 90%, the lipid core comprised >10% of the plaque area (Fig. 3). Furthermore, almost 65% of plaque ruptures had >25% area of the plaque occupied by the necrotic core. In contrast, nearly 75% of TCFA have >10% area of the plaque occupied by necrotic core. The mean cross-section area narrowing of the TCFA is 71%, and most have 10% to 25% of the cross sectional area occupied by a necrotic core. The length of the necrotic core in ruptures and TCFAs is similar, varying from 2 to 22.5 mm, with mean of 8 and 9 mm, respectively (Table 3) (6).


Figure 3
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Figure 3 Coronary plaque erosion. (A) Shows a low-power view of a coronary artery obstructed by a luminal thrombus (Th) with no established communication with the deep underlying plaque consistent with plaque erosion (Movat Pentachrome, x20). The plaque substrate shows a large lipid pool (Lp) with superficial smooth muscle cells and proteoglycans (bluish-green stain). (B) Eroded lesions with a necrotic core (Nc). There is a non-occlusive luminal thrombus with partial organization. (C) High-power view of the plaque/thrombus (Th) interface in the lesion shown in panel A, showing an absence of endothelium and a substrate rich in smooth muscle cells and proteoglycan matrix (x400). (Figure 3A is reproduced form Kolodgie FD, Burke AP, Farb A, et al. Arherioscler Throm Vasc Biol 2002;22:1642–8. Figures 3B and 3C are reproduced with permission from Kolodgie FD, Burke AP, Wight TN, et al. Curr Opin Lipidol 2004;15:575–82.)

 

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Table 3. Approximate Sizes of Necrotic Core in Fibroatheroma, Thin Cap Atheroma, and Acute Plaque Rupture
 
In 38 hearts with severe coronary luminal narrowing, in which the coronary arteries had been serially cut from coronary ostium to intramyocardial location, the mean luminal narrowing was least in sections with thin cap atheroma (59.6%), intermediate for hemorrhage into a plaque (68.8%), and highest in plaque rupture (73.3%) or healed plaque rupture (72.8%) (6). Overall, approximately 75% of the arteries showed <75% cross-sectional luminal-narrowing, indicating that sites with <50% diameter stenosis are the most useful for the detection of vulnerable plaque. Over 50% of the TCFAs occur in the proximal portions of the major coronary arteries, left anterior, left circumflex and the right, and another one-third in the mid portion of these arteries, and the rest are distributed in distal segments (5). A similar distribution is found in ruptures and healed plaque ruptures.


    Role of monocyte infiltration of the occlusive thrombus
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 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
The rupture of the fibrous cap allows platelets and inflammatory cells to come in contact with the thrombogenic substrate, the necrotic core. Before the report of Nemerson et al. (14), the core was thought to be the main source of the tissue factor. It is now believed that circulating monocytes, instead of plaque macrophages, supply tissue factor that trigger and propagate acute thrombi overlying unstable coronary atherosclerotic plaques. We have shown that monocyte infiltration of the thrombus correlates with the presence of an occlusive thrombus (7). Monocytes and neutrophils were identified in the fibrous cap by myeloperoxidase (MPO) staining. In clots, occlusive thrombi have greater density of CD68-positive macrophage (15.7 ± 12.5% vs. 3.0 ± 2.7%, p = 0.05) and MPO-positive monocytes (12.2 ± 7.5% vs. 5.0 ± 2.7%, p = 0.006) and neutrophils (2.9 ± 3.4% vs. 0.36 ± 0.50%, p = 0.03) than in non-occlusive thrombi. Similarly, the length of the thrombus showed a positive correlation with the intra-clot density of macrophages (p = 0.004) and MPO positive cells (p = 0.04). In the disrupted fibrous cap the density of MPO-positive cells was greater in occlusive (5.5%) versus non-occlusive (0.9%); this association was similar for neutrophils (0.7% vs. 0.4%) but not for total CD68-positive macrophages (13% vs. 20%) (7).

The precise role of MPO in triggering acute coronary thrombosis is unclear. In addition to providing a pro-oxidant milieu and increasing oxidized low-density lipoprotein cholesterol, there is evidence that macrophage MPO might be responsible for the disruption of the fibrous cap by production hypochlorous acid (8).


    Plaque erosion as the basis of ACS
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 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
Plaque erosion is defined as an acute thrombus in direct contact with the intima, in an area of absent endothelium (Fig. 3). The intimal plaque underlying plaque erosion is rich in smooth muscle cells and proteoglycan matrix (9). We speculate that coronary vasospasm might be involved in the pathophysiology of erosion. This hypothesis is based on the observation that there is lack of endothelium and the media in these segments is intact and is thicker than at sites of plaque rupture (15). There are usually few or absent macrophages and lymphocytes in plaque erosions. The lesions tend to be eccentric and are infrequently calcified. The underlying plaque in erosions consists of pathologic intimal thickening or fibrous cap atheroma. The most frequent location for both erosion and rupture is the proximal left anterior descending artery (66%) followed by the right (18%) and the left circumflex (14%). Single (56%) vessel disease is twice as frequent as double vessel (26%) disease. Plaque erosions tend to embolize more frequently than plaque rupture (74% vs. 40%, respectively) (10).

Plaque erosion accounts for 20% of all sudden deaths or 40% of coronary thrombi in patients dying suddenly with coronary artery atherosclerosis (1,3,4). The risk factors for erosion are poorly understood and are different from those of rupture. Consistently, plaque erosion is associated with smoking, especially in women. On average, patients are younger than those with plaque rupture, and there is less severe narrowing at sites of thrombosis. Plaque erosion accounts for over 80% of thrombi occurring in women <50 years of age.


    Calcified nodule as the basis of ACS
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 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
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The least frequent lesion of thrombosis shows a plaque that is heavily calcified consisting of calcified plates and surrounding area of fibrosis in the presence or absence of a necrotic core (Fig. 4). The luminal region of the plaque shows presence of breaks in the calcified plate, bone formation, and interspersed fibrin with a disrupted surface fibrous cap and an overlying thrombus. There is often fibrin present in between the bony spicules along with osteoblasts and osteoclasts and inflammatory cells (4). It is more common in older male individuals than women. We believe that these lesions are commoner in the carotid arteries than the coronary and might be related to the frequent occurrence of plaque hemorrhage.


Figure 4
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Figure 4 Calcified nodule. (A) Low-power view coronary artery showing a heavily calcified eccentric plaque with eruptive calcified nodules (Movat Pentachrome, x20). (B) Higher-power view of the plaque surface of the lesion in A, showing eruptive nodules with accumulated fibrin (x400).

 

    Coronary calcification
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 Plaque rupture as the...
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 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
Coronary calcification correlates highly with plaque burden, but its effect on plaque instability is less evident. The earliest calcification in coronary lesions occurs in apoptotic smooth muscle cells, which form membrane-bound vesicles that actively calcify. With coalescence of microscopic calcium deposits, large granules and plates of calcium form that can be visualized by standard imaging techniques. Calcification of coronary arteries increases with aging of the population, and women show a 10-year lag compared with men, with equalization by the 8th decade (11). In a series of sudden death cases, over 50% of TCFA showed a lack of calcification or only speckled calcification on postmortem radiographs of coronary arteries (12). In the remaining lesions, calcification was almost equally divided into fragmented or diffuse, suggesting a large variation in the degree of calcification within the "TCFA." In contrast, 65% of acute ruptures show speckled calcification, with the remainder showing fragmented or diffuse. Plaque erosion is almost devoid of calcification or, when present, there is only speckled calcification. Calcified nodules are lesion with the greatest amount of calcification relative to plaque area with even bone formation. This type of lesion, however, only rarely triggers thrombosis and tends to occur in the right or left anterior descending coronary artery of older individuals (4). It has been reported that calcification is greater in sudden coronary death victims than in those dying with acute myocardial infarction or unstable angina in arteries with 76% to 100% cross-sectional luminal narrowing (16,17). In our experience, however, calcification is dependent on the age of the patient in sudden coronary death victims; radiographic coronary calcification is present in 46% of men and women under the age of 40 years, 79% of men and women ages 50 to 60 years, and 100% of those older than 60 years (11). For women, the degree of calcification shows a 10-year lag compared with that of men, with equalization by the eighth decade (11).


    Correlation of risk factors with ACS pathology
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 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
We have reported our findings relating coronary plaque morphology and risk factors in sudden coronary death. Thin-cap fibroatheromas are a frequent finding in men dying suddenly with coronary thrombosis and are most frequent in patients with high total cholesterol (TC) and TC/high-density lipoprotein (HDL) cholesterol ratio (>210 mg/dl and TC/HDL cholesterol ratio >5) (1). The incidence of TCFA in women is most frequent in women >50 years and also in those with TC >210 mg/dl (2). Smoking shows a positive correlation with presence of thrombosis in sudden coronary death and more so in women patients with plaque erosion as compared with rupture (2). Plaques of premenopausal women demonstrate relatively little necrotic core and calcification compared with post-menopausal women and men, which might be because of the relatively high rate of plaque erosion in young women (2). Another risk factor that has been reported to predict the development of ACS is C-reactive protein (CRP) (lower limit of normal is ≤3 mg/ml). The increased relative risk of sudden cardiac death associated with CRP is seen only in those in the highest quartile, who were at a 2.78-fold increased risk of sudden cardiac death (95% confidence interval 1.35 to 5.72) compared with men in the lowest quartile (18). We have shown that the median CRP was significantly higher in sudden coronary death victims dying of plaque rupture, erosion, or stable plaque than control subjects dying of noncoronary conditions (control CRP 1.4 µg/dl vs. sudden death 2.7 µg/dl, p < 0.0001), and by multivariate analysis, log-transformed CRP levels were associated with plaque burden (p = 0.03), independent of age, gender, smoking, and BMI (19). Immunohistochemically, CRP was localized to necrotic core and macrophages and was strongest in patients with high CRP as compared with those with low CRP. In addition, mean number of thin-cap atheromas was most frequent (3.0 ± 0.3) in patients with high CRP than in those with lower CRP (0.95 ± 0.22) (19).


    Conclusions
 Top
 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
The TCFA has been postulated to be the precursor lesion of plaque rupture and is most frequently observed in patients dying with acute plaque rupture and least frequent in plaque erosion. It usually occurs with lesions showing <50% diameter stenosis and is mostly observed in the proximal left anterior descending, left circumflex, and right coronary arteries, followed by mid and is least frequent in distal coronary arteries. Thin-cap fibroatheroma lesion differ from plaque ruptures in that they have smaller necrotic core, less macrophage infiltration of the thin-fibrous cap that is <65 µm in thickness and are less calcified. Risk factors include high TC, low HDLs, a high TC/HDL ratio, and a high high-sensitivity CRP level; however, the direct relationship between TCFA and plaque rupture needs to be proven in prospective randomized clinical trials once we have modalities to recognize the lesion by invasive or non-invasive means.


    Footnotes
 
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army, the Department of the Air Force, or the Department of Defense. Dr. William A. Zoghbi acted as guest editor.


    References
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 Abstract
 Plaque rupture as the...
 Location, length, and percent...
 Role of monocyte infiltration...
 Plaque erosion as the...
 Calcified nodule as the...
 Coronary calcification
 Correlation of risk factors...
 Conclusions
 References
 
1. Burke AP, Farb A, Malcom GT, et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly N Engl J Med 1997;336:1276-1282.[CrossRef][Web of Science][Medline]

2. Burke AP, Farb A, Malcom GT, et al. Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women Circulation 1998;97:2110-2116.[Abstract/Free Full Text]

3. Farb A, Tang AL, Burke AP, et al. Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction Circulation 1995;92:1701-1709.[Abstract/Free Full Text]

4. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary deatha comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000;20:1262-1275.[Free Full Text]

5. Kolodgie FD, Burke AP, Farb A, et al. The thin-cap fibroatheroma: a type of vulnerable plaque: the major precursor lesion to acute coronary syndromes Curr Opin Cardiol 2001;16:285-292.[CrossRef][Web of Science][Medline]

6. Virmani R, Burke AP, Kolodgie FD, Farb A. Vulnerable plaquethe pathology of unstable coronary lesions. J Interv Cardiol 2002;15:439-446.[Medline]

7. Burke AP, Kolodgie FD, Farb A, Weber D, Virmani R. Role of circulating myeloperoxidase positive monocytes and neutrophils in occlusive coronary thrombi J Am Coll Cardiol 2002;39:256A.

8. Sugiyama S, Okada Y, Sukhova GK, et al. Macrophage myeloperoxidase regulation by granulocyte macrophage colony-stimulating factor in human atherosclerosis and implications in acute coronary syndromes Am J Pathol 2001;158:879-891.[Web of Science][Medline]

9. Farb A, Burke AP, Tang AL, et al. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death Circulation 1996;93:1354-1363.[Abstract/Free Full Text]

10. Farb A, Burke AP, Kolodgie FD, et al. Platelet-rich intramyocardial thromboemboli are frequent in acute coronary thrombosis, especially plaque erosions Circulation 2000;102:II774.

11. Burke AP, Virmani R, Galis Z, Haudenschild CC, Muller JE. 34th Bethesda Conferencetask force 2—what is the pathologic basis for new atherosclerosis imaging techniques?. J Am Coll Cardiol 2003;41:1874-1886.[Free Full Text]

12. Burke AP, Weber DK, Kolodgie FD, et al. Pathophysiology of calcium deposition in coronary arteries Herz 2001;26:239-244.[CrossRef][Web of Science][Medline]

13. Arbustini E, Dal Bello B, Morbini P, et al. Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction Heart 1999;82:269-272.[Abstract/Free Full Text]

14. Nemerson Y. A simple experiment and a weakening paradigmthe contribution of blood to propensity for thrombus formation. Arterioscler Thromb Vasc Biol 2002;22:1369.[Free Full Text]

15. Hao H, Gabbiani G, Camenzind E, Bacchetta M, Virmani R, Bochaton-Piallatt ML. Phenotypic modulation of intima and medial smooth muscle cells in fatal cases of coronary artery lesions Arterioscler Thromb Vasc Biol 2006;26:326-332.[Abstract/Free Full Text]

16. Kragel AH, Gertz SD, Roberts WC. Morphologic comparison of frequency and types of acute lesions in the major epicardial coronary arteries in unstable angina pectoris, sudden coronary death and acute myocardial infarction J Am Coll Cardiol 1991;18:801-808.[Abstract]

17. Kragel AH, Reddy SG, Wittes JT, Roberts WC. Morphometric analysis of the composition of coronary arterial plaques in isolated unstable angina pectoris with pain at rest Am J Cardiol 1990;66:562-567.[CrossRef][Web of Science][Medline]

18. Albert CM, Ma J, Rifai N, Stampfer MJ, Ridker PM. Prospective study of C-reactive protein, homocysteine, and plasma lipid levels as predictors of sudden cardiac death Circulation 2002;105:2595-2599.[Abstract/Free Full Text]

19. Burke AP, Tracy RP, Kolodgie F, et al. Elevated C-reactive protein values and atherosclerosis in sudden coronary deathassociation with different pathologies. Circulation 2002;105:2019-2023.[Abstract/Free Full Text]




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RadiologyHome page
S. Lim, H. Shin, Y. Lee, J. Won Yoon, S. M. Kang, S. H. Choi, K. S. Park, H. C. Jang, S. I. Choi, and E. J. Chun
Effect of Metabolic Syndrome on Coronary Artery Stenosis and Plaque Characteristics as Assessed with 64-Detector Row Cardiac CT
Radiology, November 1, 2011; 261(2): 437 - 445.
[Abstract] [Full Text] [PDF]


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ANGIOLOGYHome page
S. S. Soskic, B. D. Dobutovic, E. M. Sudar, M. M. Obradovic, D. M. Nikolic, B. L. Zaric, S. D. Stojanovic, E. J. Stokic, D. P. Mikhailidis, and E. R. Isenovic
Peroxisome Proliferator-Activated Receptors and Atherosclerosis
Angiology, October 1, 2011; 62(7): 523 - 534.
[Abstract] [PDF]


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Br. J. Radiol.Home page
J.-H. Buhk, A.-K. Finck-Wedel, R. Buchert, P. Bannas, B. Schnackenburg, F. U. Beil, G. Adam, and C. Weber
Screening for atherosclerotic plaques in the abdominal aorta in high-risk patients with multicontrast-weighted MRI: a prospective study at 3.0 and 1.5 tesla
Br. J. Radiol., October 1, 2011; 84(1006): 883 - 889.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
Y. J. Hong, M. H. Jeong, Y. H. Choi, J. S. Ko, M. G. Lee, W. Y. Kang, S. E. Lee, S. H. Kim, K. H. Park, D. S. Sim, et al.
Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis
Eur. Heart J., August 2, 2011; 32(16): 2059 - 2066.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
R. Diletti, H. M. Garcia-Garcia, J. Gomez-Lara, S. Brugaletta, J. J. Wykrzykowska, N. van Ditzhuijzen, R. J. van Geuns, E. Regar, G. Ambrosio, and P. W. Serruys
Assessment of Coronary Atherosclerosis Progression and Regression at Bifurcations Using Combined IVUS and OCT
J. Am. Coll. Cardiol. Img., July 1, 2011; 4(7): 774 - 780.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
F. Hyafil, E. Vucic, J.-C. Cornily, R. Sharma, V. Amirbekian, F. Blackwell, E. Lancelot, C. Corot, V. Fuster, Z. S. Galis, et al.
Monitoring of arterial wall remodelling in atherosclerotic rabbits with a magnetic resonance imaging contrast agent binding to matrix metalloproteinases
Eur. Heart J., June 2, 2011; 32(12): 1561 - 1571.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
M. A. Vink, M. C. Kramer, X. Li, P. Damman, S. Z. Rittersma, K. T. Koch, A. C. van der Wal, J. G. P. Tijssen, and R. J. de Winter
Clinical and Angiographic Predictors and Prognostic Value of Failed Thrombus Aspiration in Primary Percutaneous Coronary Intervention
J. Am. Coll. Cardiol. Intv., June 1, 2011; 4(6): 634 - 642.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
S. E. P. New and E. Aikawa
Molecular Imaging Insights Into Early Inflammatory Stages of Arterial and Aortic Valve Calcification
Circ. Res., May 27, 2011; 108(11): 1381 - 1391.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
D. Vancraeynest, A. Pasquet, V. Roelants, B. L. Gerber, and J.-L. J. Vanoverschelde
Imaging the Vulnerable Plaque
J. Am. Coll. Cardiol., May 17, 2011; 57(20): 1961 - 1979.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
T. Yonetsu, T. Kakuta, T. Lee, K. Takahashi, N. Kawaguchi, G. Yamamoto, K. Koura, K. Hishikari, Y. Iesaka, H. Fujiwara, et al.
In vivo critical fibrous cap thickness for rupture-prone coronary plaques assessed by optical coherence tomography
Eur. Heart J., May 2, 2011; 32(10): 1251 - 1259.
[Abstract] [Full Text] [PDF]


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Circ Cardiovasc ImagingHome page
M. M. McDermott, K. Liu, J. Carr, M. H. Criqui, L. Tian, D. Li, L. Ferrucci, J. M. Guralnik, C. M. Kramer, C. Yuan, et al.
Superficial Femoral Artery Plaque, the Ankle-Brachial Index, and Leg Symptoms in Peripheral Arterial Disease: The Walking and Leg Circulation Study (WALCS) III
Circ Cardiovasc Imaging, May 1, 2011; 4(3): 246 - 252.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
G. P. Fadini, M. Albiero, L. Menegazzo, E. Boscaro, S. Vigili de Kreutzenberg, C. Agostini, A. Cabrelle, G. Binotto, M. Rattazzi, E. Bertacco, et al.
Widespread Increase in Myeloid Calcifying Cells Contributes to Ectopic Vascular Calcification in Type 2 Diabetes
Circ. Res., April 29, 2011; 108(9): 1112 - 1121.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
N. Gonzalo, G. J. Tearney, G. van Soest, P. Serruys, H. M. Garcia-Garcia, B. E. Bouma, and E. Regar
Witnessed Coronary Plaque Rupture During Cardiac Catheterization
J. Am. Coll. Cardiol. Img., April 1, 2011; 4(4): 437 - 438.
[Full Text] [PDF]


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Eur Heart J Cardiovasc ImagingHome page
M. Hartmann, J. Huisman, D. Bose, L. O. Jensen, P. Schoenhagen, G. S. Mintz, R. Erbel, and C. von Birgelen
Serial intravascular ultrasound assessment of changes in coronary atherosclerotic plaque dimensions and composition: an update
Eur Heart J Cardiovasc Imaging, April 1, 2011; 12(4): 313 - 321.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
F. Leuschner and M. Nahrendorf
Molecular Imaging of Coronary Atherosclerosis and Myocardial Infarction: Considerations for the Bench and Perspectives for the Clinic
Circ. Res., March 4, 2011; 108(5): 593 - 606.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J. L. Johnson, L. Devel, B. Czarny, S. J. George, C. L. Jackson, V. Rogakos, F. Beau, A. Yiotakis, A. C. Newby, and V. Dive
A Selective Matrix Metalloproteinase-12 Inhibitor Retards Atherosclerotic Plaque Development in Apolipoprotein E-Knockout Mice
Arterioscler Thromb Vasc Biol, March 1, 2011; 31(3): 528 - 535.
[Abstract] [Full Text] [PDF]


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Circ Cardiovasc ImagingHome page
R. D. Madder, K. M. Chinnaiyan, A. M. Marandici, and J. A. Goldstein
Features of Disrupted Plaques by Coronary Computed Tomographic Angiography: Correlates With Invasively Proven Complex Lesions
Circ Cardiovasc Imaging, March 1, 2011; 4(2): 105 - 113.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Barseghian, D. Gawande, and M. Bajaj
Adiponectin and Vulnerable Atherosclerotic Plaques
J. Am. Coll. Cardiol., February 15, 2011; 57(7): 761 - 770.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
K. C. Briley-Saebo, Y. S. Cho, P. X. Shaw, S. K. Ryu, V. Mani, S. Dickson, E. Izadmehr, S. Green, Z. A. Fayad, and S. Tsimikas
Targeted Iron Oxide Particles for In Vivo Magnetic Resonance Detection of Atherosclerotic Lesions With Antibodies Directed to Oxidation-Specific Epitopes
J. Am. Coll. Cardiol., January 18, 2011; 57(3): 337 - 347.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
C. Giannarelli, B. Ibanez, G. Cimmino, J. M. Garcia Ruiz, F. Faita, E. Bianchini, M. U. Zafar, V. Fuster, M. J. Garcia, and J. J. Badimon
Contrast-Enhanced Ultrasound Imaging Detects Intraplaque Neovascularization in an Experimental Model of Atherosclerosis
J. Am. Coll. Cardiol. Img., December 1, 2010; 3(12): 1256 - 1264.
[Abstract] [Full Text] [PDF]


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AMERICAN JOURNAL OF LIFESTYLE MEDICINEHome page
U. G. Bronas and D. R. Dengel
Influence of Vascular Oxidative Stress and Inflammation on the Development and Progression of Atherosclerosis
American Journal of Lifestyle Medicine, November 1, 2010; 4(6): 521 - 534.
[Abstract] [PDF]


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J Am Coll Cardiol ImgHome page
J. Hur, J. Park, Y. J. Kim, H.-J. Lee, H. S. Shim, K. O. Choe, and B. W. Choi
Use of Contrast Enhancement and High-Resolution 3D Black-Blood MRI to Identify Inflammation in Atherosclerosis
J. Am. Coll. Cardiol. Img., November 1, 2010; 3(11): 1127 - 1135.
[Abstract] [Full Text] [PDF]


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CirculationHome page
K. Morishige, D. F. Kacher, P. Libby, L. Josephson, P. Ganz, R. Weissleder, and M. Aikawa
High-Resolution Magnetic Resonance Imaging Enhanced With Superparamagnetic Nanoparticles Measures Macrophage Burden in Atherosclerosis
Circulation, October 26, 2010; 122(17): 1707 - 1715.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
H. M. Garcia-Garcia, M. A. Costa, and P. W. Serruys
Imaging of coronary atherosclerosis: intravascular ultrasound
Eur. Heart J., October 2, 2010; 31(20): 2456 - 2469.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
S.-Y. Shai, S. Sukhanov, Y. Higashi, C. Vaughn, J. Kelly, and P. Delafontaine
Smooth Muscle Cell-Specific Insulin-Like Growth Factor-1 Overexpression in Apoe-/- Mice Does Not Alter Atherosclerotic Plaque Burden but Increases Features of Plaque Stability
Arterioscler Thromb Vasc Biol, October 1, 2010; 30(10): 1916 - 1924.
[Abstract] [Full Text] [PDF]


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ANN INTERN MEDHome page
A. A. Alsheikh-Ali, G. D. Kitsios, E. M. Balk, J. Lau, and S. Ip
The Vulnerable Atherosclerotic Plaque: Scope of the Literature
Ann Intern Med, September 21, 2010; 153(6): 387 - 395.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
J. Hjortnaes, J. Butcher, J.-L. Figueiredo, M. Riccio, R. H. Kohler, K. M. Kozloff, R. Weissleder, and E. Aikawa
Arterial and aortic valve calcification inversely correlates with osteoporotic bone remodelling: a role for inflammation
Eur. Heart J., August 2, 2010; 31(16): 1975 - 1984.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
P. Donnelly, P. Maurovich-Horvat, M. Vorpahl, M. Nakano, R. K. Kaple, W. Warger, A. Tanaka, G. Tearney, R. Virmani, and U. Hoffmann
Multimodality Imaging Atlas of Coronary Atherosclerosis
J. Am. Coll. Cardiol. Img., August 1, 2010; 3(8): 876 - 880.
[Full Text] [PDF]


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StrokeHome page
H. Ota, M. J. Reeves, D. C. Zhu, A. Majid, A. Collar, C. Yuan, and J. K. DeMarco
Sex Differences in Patients With Asymptomatic Carotid Atherosclerotic Plaque: In Vivo 3.0-T Magnetic Resonance Study
Stroke, August 1, 2010; 41(8): 1630 - 1635.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
S. Takarada, T. Imanishi, K. Ishibashi, T. Tanimoto, K. Komukai, Y. Ino, H. Kitabata, T. Kubo, A. Tanaka, K. Kimura, et al.
The Effect of Lipid and Inflammatory Profiles on the Morphological Changes of Lipid-Rich Plaques in Patients With Non-ST-Segment Elevated Acute Coronary Syndrome: Follow-Up Study by Optical Coherence Tomography and Intravascular Ultrasound
J. Am. Coll. Cardiol. Intv., July 1, 2010; 3(7): 766 - 772.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
H. Williams, J. L. Johnson, C. L. Jackson, S. J. White, and S. J. George
MMP-7 mediates cleavage of N-cadherin and promotes smooth muscle cell apoptosis
Cardiovasc Res, July 1, 2010; 87(1): 137 - 146.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. H. F. Rudd, J. Narula, H. W. Strauss, R. Virmani, J. Machac, M. Klimas, N. Tahara, V. Fuster, E. A. Warburton, Z. A. Fayad, et al.
Imaging Atherosclerotic Plaque Inflammation by Fluorodeoxyglucose With Positron Emission Tomography: Ready for Prime Time?
J. Am. Coll. Cardiol., June 8, 2010; 55(23): 2527 - 2535.
[Abstract] [Full Text] [PDF]


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SEMIN CARDIOTHORAC VASC ANESTHHome page
G. W. van Lammeren, J. P. P. M. de Vries, A. Vink, D. P. V. de Kleijn, F. L. Moll, and G. Pasterkamp
New Predictors of Adverse Cardiovascular Events Following Vascular Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2010; 14(2): 148 - 153.
[Abstract] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
A. R. Nawrocki, S. M. Hofmann, D. Teupser, J. E. Basford, J. L. Durand, L. A. Jelicks, C. W. Woo, G. Kuriakose, S. M. Factor, H. B. Tanowitz, et al.
Lack of Association Between Adiponectin Levels and Atherosclerosis in Mice
Arterioscler Thromb Vasc Biol, June 1, 2010; 30(6): 1159 - 1165.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
K. Smedlund, J.-Y. Tano, and G. Vazquez
The Constitutive Function of Native TRPC3 Channels Modulates Vascular Cell Adhesion Molecule-1 Expression in Coronary Endothelial Cells Through Nuclear Factor {kappa}B Signaling
Circ. Res., May 14, 2010; 106(9): 1479 - 1488.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
K. Toutouzas, E. Tsiamis, A. Karanasos, M. Drakopoulou, A. Synetos, C. Tsioufis, D. Tousoulis, P. Davlouros, D. Alexopoulos, K. Bouki, et al.
Morphological Characteristics of Culprit Atheromatic Plaque Are Associated With Coronary Flow After Thrombolytic Therapy: New Implications of Optical Coherence Tomography From a Multicenter Study
J. Am. Coll. Cardiol. Intv., May 1, 2010; 3(5): 507 - 514.
[Abstract] [Full Text] [PDF]


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RadiologyHome page
D. R. Owen, J. Shalhoub, S. Miller, T. Gauthier, O. Doryforou, A. H. Davies, and E. L. S. Leen
Inflammation within Carotid Atherosclerotic Plaque: Assessment with Late-Phase Contrast-enhanced US
Radiology, May 1, 2010; 255(2): 638 - 644.
[Abstract] [Full Text] [PDF]


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JNMHome page
M. O'Donnell, E. R. McVeigh, H. W. Strauss, A. Tanaka, B. E. Bouma, G. J. Tearney, M. A. Guttman, and E. V. Garcia
Multimodality Cardiovascular Molecular Imaging Technology
J. Nucl. Med., May 1, 2010; 51(Supplement_1): 38S - 50S.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
S. H. Kim, E. S. Lee, J. Y. Lee, E. S. Lee, B. S. Lee, J. E. Park, and D. W. Moon
Multiplex Coherent Anti-Stokes Raman Spectroscopy Images Intact Atheromatous Lesions and Concomitantly Identifies Distinct Chemical Profiles of Atherosclerotic Lipids
Circ. Res., April 30, 2010; 106(8): 1332 - 1341.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. Kubo, A. Maehara, G. S. Mintz, H. Doi, K. Tsujita, S. Y. Choi, O. Katoh, K. Nasu, A. Koenig, M. Pieper, et al.
The Dynamic Nature of Coronary Artery Lesion Morphology Assessed by Serial Virtual Histology Intravascular Ultrasound Tissue Characterization
J. Am. Coll. Cardiol., April 13, 2010; 55(15): 1590 - 1597.
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Circ. Res.Home page
G. Pasterkamp and D. de Kleijn
Cold War Battle Against Hot Atherosclerotic Plaques
Circ. Res., April 2, 2010; 106(6): 1017 - 1018.
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J Am Coll Cardiol ImgHome page
P. Maurovich-Horvat, U. Hoffmann, M. Vorpahl, M. Nakano, R. Virmani, and H. Alkadhi
The Napkin-Ring Sign: CT Signature of High-Risk Coronary Plaques?
J. Am. Coll. Cardiol. Img., April 1, 2010; 3(4): 440 - 444.
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J Am Coll CardiolHome page
S. Ohshima, S. Fujimoto, A. Petrov, H. Nakagami, N. Haider, J. Zhou, N. Tahara, M. K. Osako, A. Fujimoto, J. Zhu, et al.
Effect of an Antimicrobial Agent on Atherosclerotic Plaques: Assessment of Metalloproteinase Activity by Molecular Imaging
J. Am. Coll. Cardiol., March 23, 2010; 55(12): 1240 - 1249.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
I. Gottlieb, J. M. Miller, A. Arbab-Zadeh, M. Dewey, M. E. Clouse, L. Sara, H. Niinuma, D. E. Bush, N. Paul, A. L. Vavere, et al.
The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography
J. Am. Coll. Cardiol., February 16, 2010; 55(7): 627 - 634.
[Abstract] [Full Text] [PDF]


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Am. J. Neuroradiol.Home page
L. Dong, H.R. Underhill, W. Yu, H. Ota, T.S. Hatsukami, T.L. Gao, Z. Zhang, M. Oikawa, X. Zhao, and C. Yuan
Geometric and Compositional Appearance of Atheroma in an Angiographically Normal Carotid Artery in Patients with Atherosclerosis
AJNR Am. J. Neuroradiol., February 1, 2010; 31(2): 311 - 316.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
S. Philipp, D. Bose, W. Wijns, S. P. Marso, R. S. Schwartz, A. Konig, A. Lerman, H. M. Garcia-Garcia, P. W. Serruys, and R. Erbel
Do systemic risk factors impact invasive findings from virtual histology? Insights from the international virtual histology registry
Eur. Heart J., January 2, 2010; 31(2): 196 - 202.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol ImgHome page
M. Gossl, D. Versari, H. A. Hildebrandt, T. Bajanowski, G. Sangiorgi, R. Erbel, E. L. Ritman, L. O. Lerman, and A. Lerman
Segmental Heterogeneity of Vasa Vasorum Neovascularization in Human Coronary Atherosclerosis
J. Am. Coll. Cardiol. Img., January 1, 2010; 3(1): 32 - 40.
[Abstract] [Full Text] [PDF]


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Diabetes and Vascular Disease ResearchHome page
S. P. Marso, J. A. House, V. Klauss, A. Lerman, P. Margolis, and M. B. Leon
Diabetes mellitus is associated with plaque classified as thin cap fibroatheroma: an intravascular ultrasound study
Diabetes and Vascular Disease Research, January 1, 2010; 7(1): 14 - 19.
[Abstract] [PDF]


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HeartHome page
J E van Velzen, J D Schuijf, F R de Graaf, G Nucifora, G Pundziute, J W Jukema, M J Schalij, L J Kroft, A de Roos, J H C Reiber, et al.
Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis
Heart, December 15, 2009; 95(24): 1990 - 1996.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
R. S. Schwartz, A. Burke, A. Farb, D. Kaye, J. R. Lesser, T. D. Henry, and R. Virmani
Microemboli and Microvascular Obstruction in Acute Coronary Thrombosis and Sudden Coronary Death: Relation to Epicardial Plaque Histopathology
J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2167 - 2173.
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VASC ENDOVASCULAR SURGHome page
P. Heider, J. Pelisek, H. Poppert, and H.-H. Eckstein
Evaluation of Serum Matrix Metalloproteinases as Biomarkers for Detection of Neurological Symptoms in Carotid Artery Disease
Vascular and Endovascular Surgery, December 1, 2009; 43(6): 551 - 560.
[Abstract] [PDF]


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Eur Heart JHome page
E. Gurfinkel, C. Vigliano, J. V. Janavel, D. Fornoni, G. Caponi, P. C. Meckert, A. Bertolotti, R. Favaloro, and R. Laguens
Presence of vulnerable coronary plaques in middle-aged individuals who suffered a brain death
Eur. Heart J., December 1, 2009; 30(23): 2845 - 2853.
[Abstract] [Full Text] [PDF]


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CirculationHome page
G. Heusch, P. Kleinbongard, D. Bose, B. Levkau, M. Haude, R. Schulz, and R. Erbel
Coronary Microembolization: From Bedside to Bench and Back to Bedside
Circulation, November 3, 2009; 120(18): 1822 - 1836.
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Circ Cardiovasc IntervHome page
A. Maehara, G. S. Mintz, and N. J. Weissman
Advances in Intravascular Imaging
Circ Cardiovasc Interv, October 1, 2009; 2(5): 482 - 490.
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J Am Coll Cardiol ImgHome page
P. K. Shah
Imaging Inflammation in Atherosclerosis: Another Step Forward
J. Am. Coll. Cardiol. Img., October 1, 2009; 2(10): 1223 - 1225.
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Arterioscler. Thromb. Vasc. Bio.Home page
H.-W. Wang, I. M. Langohr, M. Sturek, and J.-X. Cheng
Imaging and Quantitative Analysis of Atherosclerotic Lesions by CARS-Based Multimodal Nonlinear Optical Microscopy
Arterioscler Thromb Vasc Biol, September 1, 2009; 29(9): 1342 - 1348.
[Abstract] [Full Text] [PDF]


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HeartHome page
M Ni, W Q Chen, and Y Zhang
Animal models and potential mechanisms of plaque destabilisation and disruption
Heart, September 1, 2009; 95(17): 1393 - 1398.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Seehaus, K. Shahzad, M. Kashif, I. A. Vinnikov, M. Schiller, H. Wang, T. Madhusudhan, V. Eckstein, A. Bierhaus, F. Bea, et al.
Hypercoagulability Inhibits Monocyte Transendothelial Migration Through Protease-Activated Receptor-1-, Phospholipase-C{beta}-, Phosphoinositide 3-Kinase-, and Nitric Oxide-Dependent Signaling in Monocytes and Promotes Plaque Stability
Circulation, September 1, 2009; 120(9): 774 - 784.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. W. Stevens and S. R. Lentz
Countervailing Effects on Atherogenesis and Plaque Stability: A Paradoxical Benefit of Hypercoagulability?
Circulation, September 1, 2009; 120(9): 722 - 724.
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J Am Coll Cardiol IntvHome page
M.-K. Hong, D.-W. Park, C.-W. Lee, S.-W. Lee, Y.-H. Kim, D.-H. Kang, J.-K. Song, J.-J. Kim, S.-W. Park, and S.-J. Park
Effects of Statin Treatments on Coronary Plaques Assessed by Volumetric Virtual Histology Intravascular Ultrasound Analysis
J. Am. Coll. Cardiol. Intv., July 1, 2009; 2(7): 679 - 688.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J. H.F. Rudd, F. Hyafil, and Z. A. Fayad
Inflammation Imaging in Atherosclerosis
Arterioscler Thromb Vasc Biol, July 1, 2009; 29(7): 1009 - 1016.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
E. M. Laufer, M. H.M. Winkens, J. Narula, and L. Hofstra
Molecular Imaging of Macrophage Cell Death for the Assessment of Plaque Vulnerability
Arterioscler Thromb Vasc Biol, July 1, 2009; 29(7): 1031 - 1038.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. Motoyama, M. Sarai, H. Harigaya, H. Anno, K. Inoue, T. Hara, H. Naruse, J. Ishii, H. Hishida, N. D. Wong, et al.
Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 49 - 57.
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J Am Coll CardiolHome page
E. Braunwald
Noninvasive Detection of Vulnerable Coronary Plaques: Locking the Barn Door Before the Horse Is Stolen
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 58 - 59.
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CirculationHome page
C. Cheng, A. M. Noordeloos, V. Jeney, M. P. Soares, F. Moll, G. Pasterkamp, P. W. Serruys, and H. J. Duckers
Heme Oxygenase 1 Determines Atherosclerotic Lesion Progression Into a Vulnerable Plaque
Circulation, June 16, 2009; 119(23): 3017 - 3027.
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JNMHome page
F. Hyafil, J.-C. Cornily, J. H.F. Rudd, J. Machac, L. J. Feldman, and Z. A. Fayad
Quantification of Inflammation Within Rabbit Atherosclerotic Plaques Using the Macrophage-Specific CT Contrast Agent N1177: A Comparison with 18F-FDG PET/CT and Histology
J. Nucl. Med., June 1, 2009; 50(6): 959 - 965.
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J Am Coll Cardiol ImgHome page
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Serial contrast-enhanced cardiac magnetic resonance imaging demonstrates regression of hyperenhancement within the coronary artery wall in patients after acute myocardial infarction.
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J. Lipid Res.Home page
A. Phinikaridou, K. J. Hallock, Y. Qiao, and J. A. Hamilton
A robust rabbit model of human atherosclerosis and atherothrombosis
J. Lipid Res., May 1, 2009; 50(5): 787 - 797.
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Circ Cardiovasc ImagingHome page
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Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department
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J Am Coll Cardiol IntvHome page
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Incomplete Stent Apposition and Delayed Tissue Coverage Are More Frequent in Drug-Eluting Stents Implanted During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Than in Drug-Eluting Stents Implanted for Stable/Unstable Angina: Insights From Optical Coherence Tomography
J. Am. Coll. Cardiol. Intv., May 1, 2009; 2(5): 445 - 452.
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CirculationHome page
E. Aikawa, M. Aikawa, P. Libby, J.-L. Figueiredo, G. Rusanescu, Y. Iwamoto, D. Fukuda, R. H. Kohler, G.-P. Shi, F. A. Jaffer, et al.
Arterial and Aortic Valve Calcification Abolished by Elastolytic Cathepsin S Deficiency in Chronic Renal Disease
Circulation, April 7, 2009; 119(13): 1785 - 1794.
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J Am Coll Cardiol ImgHome page
N. Gonzalo, H. M. Garcia-Garcia, E. Regar, P. Barlis, J. Wentzel, Y. Onuma, J. Ligthart, and P. W. Serruys
In Vivo Assessment of High-Risk Coronary Plaques at Bifurcations With Combined Intravascular Ultrasound and Optical Coherence Tomography
J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 473 - 482.
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J Am Coll Cardiol ImgHome page
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The Vulnerable Plaque "Hypothesis": Promise, but Little Progress
J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 483 - 485.
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JNMHome page
J. J. Fox and H. W. Strauss
One Step Closer to Imaging Vulnerable Plaque in the Coronary Arteries
J. Nucl. Med., April 1, 2009; 50(4): 497 - 500.
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JNMHome page
S. Ohshima, A. Petrov, S. Fujimoto, J. Zhou, M. Azure, D. S. Edwards, T. Murohara, N. Narula, S. Tsimikas, and J. Narula
Molecular Imaging of Matrix Metalloproteinase Expression in Atherosclerotic Plaques of Mice Deficient in Apolipoprotein E or Low-Density-Lipoprotein Receptor
J. Nucl. Med., April 1, 2009; 50(4): 612 - 617.
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J. Lipid Res.Home page
P. Libby
Molecular and cellular mechanisms of the thrombotic complications of atherosclerosis
J. Lipid Res., April 1, 2009; 50(Supplement): S352 - S357.
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Circ. Res.Home page
Y. Sun, M. Ishibashi, T. Seimon, M. Lee, S. M. Sharma, K. A. Fitzgerald, A. O. Samokhin, Y. Wang, S. Sayers, M. Aikawa, et al.
Free Cholesterol Accumulation in Macrophage Membranes Activates Toll-Like Receptors and p38 Mitogen-Activated Protein Kinase and Induces Cathepsin K
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