Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-27T21:05:11.980Z Has data issue: false hasContentIssue false

1 - Pathology of carotid artery atherosclerotic disease

from Background

Published online by Cambridge University Press:  03 December 2009

By
Renu Virmani ,
Allen Burke ,
Elena Ladich  and
Frank D. Kolodgie
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Renu Virmani
Affiliation:
The International Registry of Pathology, Gaithersburg MD, USA
Allen Burke
Affiliation:
The International Registry of Pathology, Gaithersburg MD, USA
Elena Ladich
Affiliation:
The International Registry of Pathology, Gaithersburg MD, USA
Frank D. Kolodgie
Affiliation:
The International Registry of Pathology, Gaithersburg MD, USA
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
Get access

Summary

Introduction

Stroke is the third leading cause of death in the United States, accounting for 600 000 cases each year, of which about 500 000 are first attacks (American Heart Association, 2001; Heart and Stroke Statistical Update. Dallas, TX, 2001). The pathologic events leading to stroke are complex, and involve atherosclerosis of the aorta and its branches, especially the carotid artery, obstruction of blood flow by increasing plaque burden, embolization of plaque components, especially of thrombotic material, and cerebrovascular factors. The importance of plaque components that predispose to plaque disruption, in addition to the degree of stenosis, has relatively recently been appreciated in relation to cerebral ischemic events. The purpose of this chapter is to characterize atherosclerotic carotid disease in light of our knowledge of coronary atherosclerosis and relate carotid plaque morphology to cerebral ischemic syndromes with special focus on features of plaque instability. A precise understanding of the histologic features of carotid atherosclerosis should help target specific treatments that are likely to be beneficial in the prevention of a subsequent event.

Pathologic features of atherosclerosis, lessons learned from aortic and coronary artery disease

The pathologic classification of atherosclerosis is in constant evolution, and should reflect in part variation based on the size of the artery involved. Two types of lesions were initially described based on gross examination of the aorta: the fatty streak and the atheromatous plaque. The fatty streak, as the less elevated and not prone to thrombosis, was considered a precursor lesion to the advanced atheromatous plaque.

Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 1 - 21
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ambrose, J. A., Tannenbaum, M. A., Alexopoulos, D., et al. (1988). Angiographic progression of coronary artery disease and the development of myocardial infarction. Journal of American College of Cardiology, 12, 56–62.CrossRefGoogle ScholarPubMed
Amarenco, P., Cohen, A., Tzourio, C., et al. (1994). Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. New England Journal of Medicine, 331, 1474–9.CrossRefGoogle ScholarPubMed
Anayiotos, A. S., Jones, S. A., Giddens, D. P., Glagov, S. and Zarins, C. K. (1994). Shear stress at a compliant model of the human carotid bifurcation. Journal of Biomechanical Engineering, 116, 98–106.Google Scholar
Barnett, H. J., Taylor, D. W., Eliasziw, M., et al. (1998). Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. New England Journal of Medicine, 339, 1415–25.CrossRefGoogle ScholarPubMed
Barnett, H. J., Meldrum, H. E. and Eliasziw, M. (2002). The appropriate use of carotid endarterectomy. Canadian Medical Association Journal, 166, 1169–79.Google ScholarPubMed
Bassiouny, H. S., Davis, H., Massawa, N., et al. (1989). Critical carotid stenoses: morphologic and chemical similarity between symptomatic and asymptomatic plaques. Journal of Vascular Surgery, 9, 202–12.CrossRefGoogle ScholarPubMed
Bassiouny, H. S., Sakaguchi, Y., Mikucki, S. A., et al. (1997). Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. Journal of Vascular Surgery, 26, 585–94.CrossRefGoogle ScholarPubMed
Bostom, A. G., Rosenberg, I. H., Silbershatz, H., et al. (1999). Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the Framingham Study. Annals of Internal Medicine, 131, 352–5.CrossRefGoogle ScholarPubMed
Burke, A. P., Farb, A., Malcom, G. T., et al. (1997). Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. New England Journal of Medicine, 336, 1276–82.CrossRefGoogle ScholarPubMed
Burke, A. P., Kolodgie, F. D., Farb, A., et al. (2001). Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression. Circulation, 103, 934–40.CrossRefGoogle Scholar
Burke, A. P., Tracy, R. P., Kolodgie, F., et al. (2002). Elevated C-reactive protein values and atherosclerosis in sudden coronary death: association with different pathologies. Circulation, 105, 2019–23.CrossRefGoogle ScholarPubMed
Carr, S., Farb, A., Pearce, W. H., Virmani, R. and Yao, J. S. (1996). Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. Journal of Vascular Surgery, 23, 755–65; discussion 765–756.CrossRefGoogle ScholarPubMed
Chu, B., Kampschulte, A., Ferguson, M. S., et al. (2004). Hemorrhage in the atherosclerotic carotid plaque: a high-resolution Magnetic resonance imaging study. Stroke, 35, 1079–84. Epub 2004 Apr 1071.CrossRefGoogle Scholar
Clagett, G. P., Robinowitz, M., Youkey, J. R., et al. (1986). Morphogenesis and clinicopathologic characteristics of recurrent carotid disease. Journal of Vascular Surgery, 3, 10–23.CrossRefGoogle ScholarPubMed
Das, S. K., Brow, T. D. and Pepper, J. (2000). Continuing controversy in the management of concomitant coronary and carotid disease: an overview. International Journal of Cardiology, 74, 47–65.CrossRefGoogle ScholarPubMed
Davila-Roman, V. G., Barzilai, B., Wareing, T. H., et al. (1994). Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients. Stroke, 25, 2010–16.CrossRefGoogle ScholarPubMed
Droste, D. W., Dittrich, R., Kemeny, V., Schulte-Altedorneburg, G. and Ringelstein, E. B. (1999). Prevalence and frequency of microembolic signals in 105 patients with extracranial carotid artery occlusive disease. Journal of Neurology, Neurosurgery and Psychiatry, 67, 525–8.CrossRefGoogle ScholarPubMed
Ecker, R. D., Pichelmann, M. A., Meissner, I. and Meyer, F. B. (2003). Durability of carotid endarterectomy. Stroke, 34, 2941–4.CrossRefGoogle ScholarPubMed
Endarterectomy for asymptomatic carotid artery stenosis. (1995). Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Journal of the American Medical Association, 273, 1421–8.CrossRef
Farb, A., Tang, A. L., Burke, A. P., et al. (1995). Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation, 92, 1701–9.CrossRefGoogle ScholarPubMed
Frijns, C. J. and Kappelle, L. J. (2002). Inflammatory cell adhesion molecules in ischemic cerebrovascular disease. Stroke, 33, 2115–22.CrossRefGoogle ScholarPubMed
Glagov, S., Zarins, C., Giddens, D. P. and Ku, D. N. (1988). Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. Archives of Pathology and Laboratory Medicine, 112, 1018–31.Google ScholarPubMed
Goldstein, L. B., Adams, R., Becker, K., et al. (2001). Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation, 103, 163–82.CrossRefGoogle ScholarPubMed
Golledge, J., Greenhalgh, R. M. and Davies, A. H. (2000). The symptomatic carotid plaque. Stroke, 31, 774–81.CrossRefGoogle ScholarPubMed
Hunt, J. L., Fairman, R., Mitchell, M. E., et al. (2002). Bone formation in carotid plaques: a clinicopathological study. Stroke, 33, 1214–19.CrossRefGoogle ScholarPubMed
Hunter, G. C. and Edgar, J. (1997). Poth Memorial/ W. L. Gore and Associates, Inc. Lectureship. The clinical and pathological spectrum of recurrent carotid stenosis. American Journal of Surgery, 174, 583–8.CrossRefGoogle Scholar
Kolodgie, F. D., Gold, H. K., Burke, A. P., et al. (2003). Intraplaque hemorrhage and progression of coronary atheroma. New England Journal of Medicine, 349, 2316–25.CrossRefGoogle ScholarPubMed
Mann, J. and Davies, M. J. (1999). Mechanisms of progression in native coronary artery disease: role of healed plaque disruption. Heart, 82, 265–8.CrossRefGoogle ScholarPubMed
Masawa, N., Glagov, S. and Zarins, C. K. (1994). Quantitative morphologic study of intimal thickening at the human carotid bifurcation: I. Axial and circumferential distribution of maximum intimal thickening in asymptomatic, uncomplicated plaques. Atherosclerosis, 107, 137–46.CrossRefGoogle ScholarPubMed
Mauriello, A., Sangiorgi, G., Palmieri, G., et al. (2000). Hyperfibrinogenemia is associated with specific histocytological composition and complications of atherosclerotic carotid plaques in patients affected by transient ischemic attacks. Circulation, 101, 744–50.CrossRefGoogle ScholarPubMed
Mofidi, R., Crotty, T. B., McCarthy, P., et al. (2001). Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease. British Journal of Surgery, 88, 945–50.CrossRefGoogle ScholarPubMed
North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. New England Journal of Medicine, 325, 445–53.CrossRef
North American Symptomatic Carotid Endarterectomy Trial. (1991). Methods, patient characteristics, and progress. Stroke, 22, 711–20.CrossRef
Pauletto, P., Puato, M., Faggin, E., et al. (2000). Specific cellular features of atheroma associated with development of neointima after carotid endarterectomy: the carotid atherosclerosis and restenosis study. Circulation, 102, 771–8.CrossRefGoogle ScholarPubMed
Rost, N. S., Wolf, P. A., Kase, C. S., et al. (2001). Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke, 32, 2575–9.CrossRefGoogle ScholarPubMed
Saam, T., Cai, J. M., Cai, Y. Q., et al. (2005). Carotid plaque composition differs between ethno-racial groups: an Magnetic resonance imaging pilot study comparing mainland Chinese and American Caucasian patients. Arteriosclerosis, Thrombosis and Vascular Biology, 25, 611–16. Epub 2005 Jan 2013.CrossRefGoogle ScholarPubMed
Shinnar, M., Fallon, J. T., Wehrli, S., et al. (1999). The diagnostic accuracy of ex vivo Magnetic resonance imaging for human atherosclerotic plaque characterization. Arteriosclerosis, Thrombosis and Vascular Biology, 19, 2756–61.CrossRefGoogle ScholarPubMed
Sitzer, M., Muller, W., Siebler, M., et al. (1995). Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis. Stroke, 26, 1231–3.CrossRefGoogle ScholarPubMed
Spagnoli, L. G., Mauriello, A., Palmieri, G., et al. (1994). Relationships between risk factors and morphological patterns of human carotid atherosclerotic plaques. A multivariate discriminant analysis. Atherosclerosis, 108, 39–60.CrossRefGoogle ScholarPubMed
Spagnoli, L. G., Mauriello, A., Sangiorgi, G., et al. (2004). Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. Journal of the American Medical Association, 292, 1845–52.CrossRefGoogle ScholarPubMed
Stary, H. C., Chandler, A. B., Dinsmore, R. E., et al. (1995). A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation, 92, 1355–74.CrossRefGoogle Scholar
Stary, H. C., Chandler, A. B., Glagov, S., et al. (1994). A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation, 89, 2462–78.CrossRefGoogle Scholar
Stork, J. L., Kimura, K., Levi, C. R., et al. (2002). Source of microembolic signals in patients with high-grade carotid stenosis. Stroke, 33, 2014–18.CrossRefGoogle ScholarPubMed
Takaya, N., Yuan, C., Chu, B., et al. (2005). Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation, 111, 2768–75.CrossRefGoogle ScholarPubMed
The French Study of Aortic Plaques in Stroke Group Factor (clotting). (1996). Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. New England Journal of Medicine, 334, 1216–21.CrossRef
Valton, L., Larrue, V., Traon, A. P., Massabuau, P. and Geraud, G. (1998). Microembolic signals and risk of early recurrence in patients with stroke or transient ischemic attack. Stroke, 29, 2125–8.CrossRefGoogle ScholarPubMed
Verhoeven, B. A., Vries, J. P., Pasterkamp, G., et al. (2005). Carotid atherosclerotic plaque characteristics are associated with microembolization during carotid endarterectomy and procedural outcome. Stroke, 36, 1735–40. Epub 2005 Jul 1737.CrossRefGoogle ScholarPubMed
Virmani, R., Kolodgie, F. D., Burke, A. P., et al. (2000). Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arteriosclerosis, Thrombosis and Vascular Biology, 20, 1262–75.CrossRefGoogle ScholarPubMed
Wasserman, B. A., Wityk, R. J., Trout, H. H 3rd and Virmani, R. (2005). Low-grade carotid stenosis: looking beyond the lumen with Magnetic resonance imaging. Stroke, 36, 2504–13. Epub 2005 Oct 2520.CrossRefGoogle Scholar
Wolf, P. A. (1998). Prevention of stroke. Lancet, 352 (Suppl. 3), SIII15–18.CrossRefGoogle ScholarPubMed
Wolf, P. A. and Grotta, J. C. (2000). Cerebrovascular disease. Circulation, 102 (Suppl. 4), IV75–80.CrossRefGoogle ScholarPubMed
Zarins, C. K., Giddens, D. P., Bharadvaj, B. K., et al. (1983). Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circulation Research, 53, 502–14.CrossRefGoogle ScholarPubMed
Zhao, X. Q., Yuan, C., Hatsukami, T. S., et al. (2001). Effects of prolonged intensive lipid-lowering therapy on the characteristics of carotid atherosclerotic plaques in vivo by Magnetic resonance imaging: a case-control study. Arteriosclerosis,Thrombosis and Vascular Biology, 21, 1623–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×