Acute pathologic features with angiographic correlates of the nearly or completely occluded lesions of the cervical internal carotid artery.
BACKGROUND
The true pathologic process of nearly or completely occluded lesions of the cervical internal carotid artery (ICA) has not been studied sufficiently. This information is important in determining the critical indications for endarterectomy.


METHODS
Acute pathologic features of these advanced occlusive lesions of the ICA were studied in 40 patients who underwent emergency carotid endarterectomy. Gross morphologic and histopathologic features of these occlusive lesions were examined, and the relationship between the clinical information and the pathologic characteristics was investigated.


RESULTS
Thirty-seven lesions had histologic features of advanced atherosclerosis complicated by fresh intraplaque hemorrhages with or without transintimal extension. Thinwalled neovessels were thought to be an important etiologic factor in producing intraplaque hemorrhage. The remaining three lesions without these changes had strangulated embolic material at the occluded portion. A good correlation between these pathologic features and angiographic findings was found.


CONCLUSIONS
The presented results clearly indicate that intraplaque hemorrhage is the most important factor in producing and determining the acute pathologic features of symptomatic and advanced atheromatous occlusive ICA lesions.
Endo
S
S
Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Japan.
Hirashima
Y
Y
Kurimoto
M
M
Kuwayama
N
N
Nishijima
M
M
Takaku
A
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002341:Carotid Artery Thrombosis / Q000209:etiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004630:Emergencies; D016894:Endarterectomy, Carotid; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged