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The prevalence of inflammatory cells
in non ruptured atherosclerotic
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.
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
Is the presence of inflammatory cells
A- specific for plaque rupture or
B- a commonly observed phenomenon in
What is the prevalence of moderate/heavy local
inflammation in non ruptured atherosclerotic
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).
45% of all cross-sections revealed
moderate or heavy staining for
macrophages in the cap or shoulder of
non ruptured plaques.
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?
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.
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
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
Left coronary artery
Right coronary artery - + ++
- 3 4 0
+ 2 11 2
++ 0 3 0
• The presence of inflammatory cells is a
common phenomenon in non ruptured
• 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)
• 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