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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 1999;19:54-58.
Background
Plaque rupture and subsequent plaque
thrombosis is found to be associated
with the presence of inflammatory cells.
Davies et al. Br Heart J 1985;53:363-373
Van der Wal et al. Circulation 1994;89:36-44
Moreno et al. Circulation 1994;90:775-778
Plaque rupture
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?
Post mortem study:
• Atherosclerotic femoral (n=50) and coronary
arteries (n=74) 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).
positive negative
positive negative
Femoral artery
45% of all cross-sections revealed
moderate or heavy staining for
macrophages in the cap or shoulder of
non ruptured plaques.
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?
positive negative
positive negative
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.
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)
-= 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.
Left coronary artery
Right coronary artery - + ++
- 3 4 0
+ 2 11 2
++ 0 3 0
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)
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.

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204 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 1999;19:54-58.
  • 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 1985;53:363-373 Van der Wal et al. Circulation 1994;89:36-44 Moreno et al. Circulation 1994;90:775-778
  • 4. 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 (n=50) and coronary arteries (n=74) 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).
  • 8. Femoral artery 45% of all cross-sections revealed moderate or heavy staining for macrophages in the cap or shoulder of non ruptured plaques.
  • 9. 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?
  • 12. 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)
  • 14. -= 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. Left coronary artery Right coronary artery - + ++ - 3 4 0 + 2 11 2 ++ 0 3 0
  • 15. 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)
  • 16. 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.