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Histologic Assessment of Thromboemboli Due to Plaque Rupture, Plaque Erosion, or COVID-19 Microthrombi

Takao Konishi1, Kenji Kawai1, Rika Kawakami1

  • 1CVPath Institute, Gaithersburg, Maryland, USA.

JACC. Case Reports
|April 24, 2023
PubMed

Insights

Acute coronary syndromes (ACS) result from plaque rupture, erosion, or COVID-19 infection. Understanding these distinct causes of myocardial infarction is key to developing better treatments.

Area of Science:

  • Cardiovascular Pathology
  • Infectious Disease Cardiology

Background:

  • Acute coronary syndromes (ACS) represent a spectrum of clinical presentations of myocardial infarction.
  • Pathophysiological mechanisms include plaque rupture, plaque erosion, and, increasingly, COVID-19 infection.

Observation:

  • Case examples illustrate the distinct pathological findings associated with each ACS etiology.
  • Plaque rupture typically shows a lipid-rich core with overlying fibrous cap disruption.
  • Plaque erosion is characterized by endothelial damage without significant cap disruption.
  • COVID-19 infection can precipitate ACS through systemic inflammation and direct viral effects on the myocardium.

Findings:

  • Distinctive histopathological features differentiate ACS causes.
  • Plaque rupture and erosion present unique macroscopic and microscopic signatures.
  • COVID-19 associated ACS exhibits inflammatory infiltrates and potential vasculitis.

Implications:

  • A comprehensive understanding of ACS pathophysiology is crucial for targeted therapeutic development.
  • Improved diagnostic and therapeutic strategies are needed to address the diverse mechanisms of ACS.
  • Further research into the interplay between viral infections and atherothrombosis will enhance patient outcomes.

Keywords:
acute coronary syndromecardiovascular diseasemyocardial infarctionthrombus

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