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Published on: January 28, 2020
Morphological predictors of arterial remodeling in coronary atherosclerosis
Allen P Burke1, Frank D Kolodgie, Andrew Farb
1Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Insights
Arterial remodeling in coronary artery disease is linked to plaque components like inflammation and calcification. These factors influence plaque instability and vessel narrowing, impacting blood flow.
Area of Science:
- Cardiovascular Pathology
- Atherosclerosis Research
- Vascular Biology
Background:
- Arterial remodeling significantly impacts luminal patency in atherosclerotic arteries.
- The specific roles of atherosclerotic plaque components in remodeling remain under-investigated.
Purpose of the Study:
- To systematically analyze the relationship between atherosclerotic plaque components and arterial remodeling.
- To identify key plaque features associated with positive and negative remodeling in coronary arteries.
Main Methods:
- Morphometric analysis of 657 reference and 1318 plaque segments from 2885 coronary segments (36 patients).
- Classification of plaques: fibroatheroma, thin-cap fibroatheroma, intraplaque hemorrhage, rupture, erosion, or total occlusion.
- Assessment of plaque components: calcification, lipid core, macrophage burden, and fibrosis.
Main Results:
- A significant correlation between plaque area and lumen size was observed in middle and distal coronary segments, but not proximal.
- Marked expansion of the internal elastic lamina (IEL) was associated with plaque hemorrhage and thin-cap fibroatheroma (vulnerable plaque).
- Macrophage burden, lipid core size, calcification, and medial atrophy correlated with positive remodeling; fibrous areas showed negative association.
Conclusions:
- Inflammation, calcification, and medial thinning are key drivers of positive arterial remodeling.
- Positive remodeling is indicative of plaque instability in atherosclerotic coronary arteries.
Background:
Although arterial remodeling in atherosclerotic arteries affects luminal patency, the role of plaque components has not been systematically studied.
Methods And Results:
Coronary segments (n=2885) were harvested from the hearts of 36 patients who died of severe coronary artery disease after perfusion fixation. Remodeling was determined by morphometric analysis of 657 sections selected as reference segments and 1318 segments with atheromatous plaques. Atherosclerotic plaques were identified as fibroatheroma, thin-cap fibroatheroma, intraplaque hemorrhage with or without rupture or erosion, or total occlusion. Plaque components consisted of calcification, lipid core, macrophage burden, and fibrosis. There was no correlation between plaque area and lumen size in proximal arteries, unlike middle and distal segments, which demonstrated a significant correlation. Marked expansion of the internal elastic lamina (IEL) occurred in plaque hemorrhages with or without and thin-cap fibroatheroma (vulnerable plaque), whereas in erosions and total occlusions there was shrinkage of the IEL. Macrophage burden, lipid core size, calcium (in fibrous plaque and lipid core), and medial atrophy were all associated with positive remodeling; fibrous areas, however, were negatively associated with remodeling.
Conclusions:
Inflammation, calcification, and medial thinning are primary determinants of positive remodeling, which appears to be a feature of plaque instability.
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