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Bone formation in carotid plaques: a clinicopathological study.
Jennifer L Hunt1, Ronald Fairman, Marc E Mitchell
1University of Pittsburgh Medical Center, Department of Pathology and Laboratory Medicine, Philadelphia, USA.
Stroke
|May 4, 2002
Summary
Extensive calcification and bone formation in carotid plaques are linked to stability and reduced stroke symptoms. These findings suggest calcified plaques may be protective against ischemic vascular events.
Area of Science:
- Vascular Biology
- Cardiovascular Pathology
- Surgical Pathology
Background:
- Carotid endarterectomy plaques exhibit bone formation and dystrophic calcification.
- The clinical significance of these pathological findings remains unclear.
Purpose of the Study:
- To investigate the association between bone formation, extensive dystrophic calcification, and plaque stability.
- To determine if these features are protective against ischemic vascular events.
Main Methods:
- Carotid endarterectomy plaques from 142 patients were analyzed for lamellar bone, calcification, inflammation, and neovascularization.
- Immunohistochemistry was used to identify vascular endothelial cells and lymphocytes.
- Clinical data on cerebrovascular and cardiovascular events were collected.
Main Results:
- Patients with calcified plaques reported fewer stroke and transient ischemic attack symptoms (P=0.042).
- Plaques with large calcific granules were associated with less frequent stroke and transient ischemic attack (P=0.021).
- Bone formation (13% of patients) correlated with sheetlike calcifications (P=0.0001) and inversely with ulceration (P=0.048), and was associated with diabetes and coronary artery disease.
Conclusions:
- Bone formation occurs in heavily calcified carotid lesions without ulceration or hemorrhage.
- Extensive calcification in carotid plaques is associated with a lower likelihood of symptomatic disease.