Histological Analysis of Carotid Plaques: The Predictors of Stroke Risk
Norbert Svoboda1, Richard Voldřich2, Václav Mandys3
1Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, Czech Republic.
Insights
Atherosclerotic plaque instability is linked to foamy macrophages and thrombosis. Complex plaque structures, like AHA type VI, predict instability, aiding stroke risk assessment.
Area of Science:
- Cardiovascular Pathology
- Histopathology
- Atherosclerosis Research
Background:
- Atherosclerotic plaque morphology and histology are crucial for determining plaque stability.
- Understanding plaque characteristics can improve risk stratification for cardiovascular events.
Purpose of the Study:
- To identify epidemiological, morphological, and histological parameters associated with stable versus unstable atherosclerotic plaques.
- To elucidate predictors of symptomatic atherosclerotic lesions.
Main Methods:
- Analysis of 280 plaques from 269 patients, recording epidemiological and histological data.
- Histological features evaluated included calcifications, myxoid changes, bleeding, thrombosis, inflammation, macrophages, and neovascularization.
- Plaques were classified using the American Heart Association (AHA) criteria.
Main Results:
- Monofactorial analysis identified large necrotic core, thrombosis, and foamy macrophages as predictors of symptomatic plaques.
- Multifactorial analysis confirmed foamy macrophages and thrombosis as significant predictors of symptomatic stenosis.
- Symptomatic plaques were more often AHA type VI compared to asymptomatic plaques (AHA types IV-V).
Conclusions:
- Plaque instability is primarily predicted by the presence of foamy macrophages and thrombosis, not single histological features alone.
- Complex plaque structures, specifically AHA type VI, are indicative of plaque instability.
- Findings are relevant for non-invasive imaging interpretation and stroke risk estimation.
Objectives:
The morphology and histological structure of the atherosclerotic plaque seem critical to its stability. Our study aimed to identify the epidemiological, morphological and histological parameters associated with stable and unstable plaques.
Materials And Methods:
The study included 280 plaques harvested from 269 consecutive patients. Epidemiological and demographic data were recorded as well as the histological features of plaque, i.e. calcifications, myxoid changes, bleeding into plaque, presence of thrombus, inflammation, macrophages, giant cell reaction, siderophages, neovascularization and plaque ossification. All specimens were classified according to the American Heart Association (AHA).
Results:
Monofactorial analysis identified three significant histological predictors for the symptomatic plaque: a plaque with a large necrotic core (odds ratio, OR=2.0, p = 0.03), thrombosis (OR=3.7, p = 0.01) and the formation of foamy macrophages (OR=2.0, p = 0.01). Multifactorial logistic regression revealed that the presence of foamy macrophages (OR=1.9, p = 0.03) and thrombosis (OR=3.5, p = 0.02) were significant predictors of symptomatic stenosis. Symptomatic plaques were significantly more frequently classified as AHA type VI than AHA type IV-V compared to asymptomatic ones (OR=1.8, p = 0.03).
Conclusions:
Our study shows that no single histological feature, except for the presence of foamy macrophages and thrombosis on the plaque, is predictive of plaque instability. Rather, a complex plaque structure (AHA type VI) is predictive of plaque instability. Our findings should be kept in mind during the assessment of non-invasive imaging and stroke risk estimation.
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