Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi.
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Ruptured atheromatous plaques were identified by step-sectioning technique as responsible for 40 of 51 recent coronary artery thrombi and 63 larger intimal haemorrhages. The degree of pre-existing luminal narrowing at the site of rupture was decisive for whether plaque rupture caused occlusive thrombosis or just intimal haemorrhage. If the pre-existing stenosis was greater than 90% (histologically determined) then plaque rupture nearly always caused occlusive thrombosis. Clearly indicating the primary role of plaque rupture in thrombus formation were the frequent finding of plaque fragments deeply buried in the centre of the thrombus and the nature of the thrombus at the site of rupture where it consisted predominantly of platelets. Thus, a severe chronic stenosis seems to be a prerequisite for occlusive thrombus formation, but the thrombotic process itself is triggered by an acute intimal lesion.
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The integrity of the fibrous cap, comprising mostly αSMA-positive cells and associated ECM, is critical to stabilise and protect plaques from rupture.
“detailed post-mortem analyses of culprit plaques in sudden cardiac death established that the integrity of the fibrous cap, comprising mostly α SMA-positive cells and associated extracellular matrix (ECM), is critical to stabilise and protect plaques from rupture, a major cause of the clinical sequalae of atherosclerosis 142,163,168 .”
From Vascular smooth muscle cells in atherosclerosis (2019) · cites this paper as [168]
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- Authors
- Falk, E.
- Corresponding author
- Falk, E
- Venue
- Heart
- Publisher
- BMJ
- Published
- 1983-08-01
- Volume
- 50
- Issue
- 2
- Pages
- 127-134
- ISSN
- 1355-6037 (ISSN-L)
- PMC
- PMC481384
- OpenAlex
- W2164550955
- Cited by
- 1,012
- References
- 30
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 12 · 2023: 9 · 2022: 12 · 2021: 16 · 2020: 8 · 2019: 16 · 2018: 11 · 2017: 16 · 2016: 11 · 2015: 22 · 2014: 25 · 2013: 29 · 2012: 27
- FWCI
- 12.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- plaque rupture, coronary thrombosis, coronary artery disease, occlusive thrombus, platelet-rich thrombus
- MeSH terms
- Adult, Aged, Arteriosclerosis, Coronary Disease, Coronary Vessels, Female, Hemorrhage, Humans, Male, Middle Aged, Diabetes Complications
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