Plaque Rupture with Severe Pre-existing Stenosis Precipitating Coronary Thrombosis. Characteristics of Coronary Atherosclerotic Plaques Underlying Fatal Occlusive Thrombi

Overview

Journal Br Heart J

Specialty Cardiology & Vascular Diseases

Date 1983 Aug 1

PMID 6882602

Citations 139

Authors

E Falk

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

OCT-based comparative evaluation of culprit lesion morphology in very young versus older adult patients with STEMI.

Girish M, Gupta M, Maehara A, Matsumura M, Bansal A, Kunal S AsiaIntervention. 2024; 10(3):177-185.

PMID: 39347107 PMC: 11413641. DOI: 10.4244/AIJ-D-24-00013.

Statins in the Cause and Prevention of Cancer: Confounding by Indication and Mediation by Rhabdomyolysis and Phosphate Toxicity.

Brown R J Cardiovasc Dev Dis. 2024; 11(9).

PMID: 39330354 PMC: 11432391. DOI: 10.3390/jcdd11090296.

Development of Robust PEBAX-Based Angiographic Catheter: Design and In Vitro Study.

Inam H, Ali M, Jameel I, Awaiz D, Qureshi Z Materials (Basel). 2024; 17(17).

PMID: 39274637 PMC: 11396707. DOI: 10.3390/ma17174248.

Non-Coding RNA Involved in the Pathogenesis of Atherosclerosis-A Narrative Review.

Kielbowski K, Zychowska J, Bakinowska E, Pawlik A Diagnostics (Basel). 2024; 14(17).

PMID: 39272765 PMC: 11394555. DOI: 10.3390/diagnostics14171981.

Identification of a functional missense variant in the matrix metallopeptidase 10 (MMP10) gene in two families with premature myocardial infarction.

Verovenko V, Tennstedt S, Kleinecke M, Kessler T, Schunkert H, Erdmann J Sci Rep. 2024; 14(1):12212.

PMID: 38806571 PMC: 11133425. DOI: 10.1038/s41598-024-62878-3.

References

Kostis J, BAUGHMAN D, Kuo P . Association of recurrent myocardial infarction with hemostatic factors: a prospective study. Chest. 1982; 81(5):571-5. DOI: 10.1378/chest.81.5.571. View

Falk E . Coronary artery narrowing without irreversible myocardial damage or development of collaterals. Assessment of "critical" stenosis in a human model. Br Heart J. 1982; 48(3):265-71. PMC: 481240. DOI: 10.1136/hrt.48.3.265. View

Crawford T, Dexter D, TEARE R . Coronary-artery pathology in sudden death from myocardial ischaemia. A comparison by age-groups. Lancet. 1961; 1(7170):181-5. DOI: 10.1016/s0140-6736(61)91363-0. View

Chapman I . MORPHOGENESIS OF OCCLUDING CORONARY ARTERY THROMBOSIS. Arch Pathol. 1965; 80:256-61. View

Friedman M, Van den Bovenkamp G . The pathogenesis of a coronary thrombus. Am J Pathol. 1966; 48(1):19-44. PMC: 1916407. View

SINAPIUS D . [On parietal changes in coronary thrombosis. Remarks on frequency, origin and significance]. Klin Wochenschr. 1965; 43(16):875-80. DOI: 10.1007/BF01711252. View

Friedman M, Van den Bovenkamp G . The pathogenesis of coronary intramural haemorrhages. Br J Exp Pathol. 1966; 47(4):347-55. PMC: 2094555. View

SINAPIUS D . [Relationship between coronary-artery thrombosis and myocardial infarction]. Dtsch Med Wochenschr. 1972; 97(12):443-8. DOI: 10.1055/s-0028-1107374. View

Hampton J, Gorlin R . Platelet studies in patients with coronary artery disease and in their relatives. Br Heart J. 1972; 34(5):465-71. PMC: 486959. DOI: 10.1136/hrt.34.5.465. View

10.

Wu K, HOAK J . Spontaneous platelet aggregation in arterial insufficiency: mechanisms and implications. Thromb Haemost. 1976; 35(3):702-11. View

11.

Ridolfi R, Hutchins G . The relationship between coronary artery lesions and myocardial infarcts: ulceration of atherosclerotic plaques precipitating coronary thrombosis. Am Heart J. 1977; 93(4):468-86. DOI: 10.1016/s0002-8703(77)80410-9. View

12.

Horie T, Sekiguchi M, Hirosawa K . Coronary thrombosis in pathogenesis of acute myocardial infarction. Histopathological study of coronary arteries in 108 necropsied cases using serial section. Br Heart J. 1978; 40(2):153-61. PMC: 482791. DOI: 10.1136/hrt.40.2.153. View

13.

Hellstrom H . Evidence in favor of the vasospastic cause of coronary artery thrombosis. Am Heart J. 1979; 97(4):449-52. DOI: 10.1016/0002-8703(79)90391-0. View

14.

Davies M, FULTON W, Robertson W . The relation of coronary thrombosis to ischaemic myocardial necrosis. J Pathol. 1979; 127(2):99-110. DOI: 10.1002/path.1711270208. View

15.

Arkin C, Hartman A . The hypercoagulability states. CRC Crit Rev Clin Lab Sci. 1979; 10(4):397-429. DOI: 10.3109/10408367909147139. View

16.

DeWood M, Spores J, Notske R, Mouser L, Burroughs R, Golden M . Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980; 303(16):897-902. DOI: 10.1056/NEJM198010163031601. View

17.

Rentrop P, Blanke H, Karsch K, Kaiser H, Kostering H, Leitz K . Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation. 1981; 63(2):307-17. DOI: 10.1161/01.cir.63.2.307. View

18.

Davies M, Thomas T . The pathological basis and microanatomy of occlusive thrombus formation in human coronary arteries. Philos Trans R Soc Lond B Biol Sci. 1981; 294(1072):225-9. DOI: 10.1098/rstb.1981.0101. View

19.

Folts J, Gallagher K, ROWE G . Blood flow reductions in stenosed canine coronary arteries: vasospasm or platelet aggregation?. Circulation. 1982; 65(2):248-55. DOI: 10.1161/01.cir.65.2.248. View

20.

Lowe G, McArdle B, Stromberg P, LORIMER A, Forbes C, Prentice C . Increased blood viscosity and fibrinolytic inhibitor in type II hyperlipoproteinaemia. Lancet. 1982; 1(8270):472-5. DOI: 10.1016/s0140-6736(82)91450-7. View