Carotid plaque as a source of emboli in humans: a scanning electron microscopic study

Ten fresh carotid plaques obtained from patients undergoing carotid endarterectomy were fixed, and their luminal surfaces were examined with a scanning electron microscope. Luminal surface defects, characterized in scanning electron microscopy as endothelial discontinuities having diameters of 50 to 1500 microns, were a frequent finding, but their presence did not correlate well with the location of ulcers seen on angiography. Potential sources of emboli found were peels of subendothelial matrix, fibrin-platelet aggregates, fibrin-red blood cell clusters, and, possibly, damaged endothelial cells. Areas of endothelial cell injury consisting of small denuded patches, sheets of endothelial cytoplasm, and distorted endothelial cell profiles were observed. These areas resembled the type of damage seen in experimental ischemic vessel lesions and were believed to be the result of carotid cross clamping. Their presence suggests that a similar mechanism may result in loss of endothelial cells and exposure of the "raw" plaque surface in vivo.