Morphological predictors of arterial remodeling in coronary atherosclerosis
Abstract
Background — Although arterial remodeling in atherosclerotic arteries affects luminal patency, the role of plaque components has not been systematically studied. Methods and Results — Coronary segments (n=2885) were harvested from the hearts of 36 patients who died of severe coronary artery disease after perfusion fixation. Remodeling was determined by morphometric analysis of 657 sections selected as reference segments and 1318 segments with atheromatous plaques. Atherosclerotic plaques were identified as fibroatheroma, thin-cap fibroatheroma, intraplaque hemorrhage with or without rupture or erosion, or total occlusion. Plaque components consisted of calcification, lipid core, macrophage burden, and fibrosis. There was no correlation between plaque area and lumen size in proximal arteries, unlike middle and distal segments, which demonstrated a significant correlation. Marked expansion of the internal elastic lamina (IEL) occurred in plaque hemorrhages with or without and thin-cap fibroatheroma (vulnerable plaque), whereas in erosions and total occlusions there was shrinkage of the IEL. Macrophage burden, lipid core size, calcium (in fibrous plaque and lipid core), and medial atrophy were all associated with positive remodeling; fibrous areas, however, were negatively associated with remodeling. Conclusions — Inflammation, calcification, and medial thinning are primary determinants of positive remodeling, which appears to be a feature of plaque instability.
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Coronary calcification is an indicator neither of stability nor of instability of an atherosclerotic plaque.
“Coronary calcification is an indicator neither of stability nor of instability of an atherosclerotic plaque.148”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [148]
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- Authors
- Burke, A. P., Kolodgie, F. D., Farb, A., Weber, D., & Virmani, R.
- Affiliations
- Armed Forces Institute of Pathology (US)
- Venue
- Circulation
- Published
- 2002-01-22
- Volume
- 105
- Issue
- 3
- Pages
- 297-303
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2047334981
- Cited by
- 525
- References
- 29
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 11 · 2023: 11 · 2022: 12 · 2021: 17 · 2020: 14 · 2019: 17 · 2018: 11 · 2017: 26 · 2016: 25 · 2015: 26 · 2014: 25 · 2013: 24 · 2012: 28
- FWCI
- 9.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01 HL61799-02, R01HL061799)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- arterial remodeling, coronary artery disease, thin-cap fibroatheroma, vulnerable plaque, intraplaque hemorrhage, plaque rupture, plaque erosion, plaque calcification, lipid core, internal elastic lamina, plaque vulnerability
- MeSH terms
- Adult, Age Factors, Aged, Arteries, Calcinosis, Coronary Artery Disease, Coronary Vessels, Elastic Tissue, Female, Forecasting, Humans, Male, Middle Aged, Sex Factors, Multivariate Analysis, Tunica Media
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