The prevalence of inflammatory cells in non ruptured atherosclerotic plaques

1
The prevalence of inflammatory cells in non
ruptured atherosclerotic plaques

• G. Pasterkamp
• Experimental Cardiology, UMC and Interuniversity
  cardiology Institute of the Netherlands, Utrecht,
  The Netherlands
• Published in part in
• Arterioscl Thromb and Vasc Biol 19991954-58.

2
Background

• Plaque rupture and subsequent plaque thrombosis
  is found to be associated with the presence of
  inflammatory cells.
• Davies et al. Br Heart J 198553363-373
• Van der Wal et al. Circulation 19948936-44
• Moreno et al. Circulation 199490775-778

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Plaque rupture
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Question

• Is the presence of inflammatory cells
• A- specific for plaque rupture or
• B- a commonly observed phenomenon in
  atherosclerotic lesions?
• What is the prevalence of moderate/heavy local
  inflammation in non ruptured atherosclerotic
  lesions?

5
Post mortem study

• Atherosclerotic femoral (n50) and coronary
  arteries (n74) from patients that did not die of
  cardiovascular disease.
• In each artery, 4-6 non ruptured cross-sections
  revealing atherosclerosis were studied for the
  presence of macrophages (CD 68) and T-lymphocytes
  (CD45RO).

6
positive
negative
7
positive
negative
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Femoral artery

• 45 of all cross-sections revealed moderate or
  heavy staining for macrophages in the cap or
  shoulder of non ruptured plaques.

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Question

• If one would randomly stain 5-6 cross-sections
  obtained from an atherosclerotic artery for
  inflammatory cells, how often would at least one
  cross-section reveal moderate to heavy staining
  for inflammatory cells?

10
positive
negative
11
positive
negative
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Femoral arteries

• In 84 of all femoral arteries at least one
  cross-section revealed moderate or haevy staining
  for macrophages or T-lymphocytes in cap or
  shoulder of the non ruptured athertosclerotic
  plaque.

13
Question

• If one would find many cross-sections with
  inflammation in one coronary artery would that
  be predictive for the occurrence of plaque
  inflammation in another coronary artery?
• Right and left coronary arteries were compared
  within the individual (next slide)

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- no staining, moderate staining, heavy
staining, No relation was observed between the
degree of staining for inflammatory cells between
the left and right coronary artery.
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Conclusion

• The presence of inflammatory cells is a common
  phenomenon in non ruptured atherosclerotic
  lesions.
• The degree of local inflammation is locally
  determined and has no/low predictive value for
  the presence of inflammation in other arteries.
• (Pasterkamp et al. ATVB 1999, Vink et al JACC
  2001)

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Discussion

• Considering these results what is the predictive
  value of local inflammation for the occurrence of
  plaque rupture?
• Visualization of the vulnerable plaque when
  inflammation is used as marker
• Specificity for local plaque rupture or
  predictive value for plaque rupture may be
  disappointing.