title: Morphological predictors of arterial remodeling in coronary atherosclerosis.
abstract: BACKGROUND
  Although arterial remodeling in atherosclerotic arteries affects luminal patency, the role of plaque components has not been systematically studied.
  
  
  RESULTS
  Coronary segments (n=2885) were harvested from the hearts of 36 patients who died of severe coronary artery disease after perfusion fixation. Remodeling was determined by morphometric analysis of 657 sections selected as reference segments and 1318 segments with atheromatous plaques. Atherosclerotic plaques were identified as fibroatheroma, thin-cap fibroatheroma, intraplaque hemorrhage with or without rupture or erosion, or total occlusion. Plaque components consisted of calcification, lipid core, macrophage burden, and fibrosis. There was no correlation between plaque area and lumen size in proximal arteries, unlike middle and distal segments, which demonstrated a significant correlation. Marked expansion of the internal elastic lamina (IEL) occurred in plaque hemorrhages with or without and thin-cap fibroatheroma (vulnerable plaque), whereas in erosions and total occlusions there was shrinkage of the IEL. Macrophage burden, lipid core size, calcium (in fibrous plaque and lipid core), and medial atrophy were all associated with positive remodeling; fibrous areas, however, were negatively associated with remodeling.
  
  
  CONCLUSIONS
  Inflammation, calcification, and medial thinning are primary determinants of positive remodeling, which appears to be a feature of plaque instability.
authors.affiliation: Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
authors.forename: Allen P
authors.initials: AP
authors.lastname: Burke
authors.forename: Frank D
authors.initials: FD
authors.lastname: Kolodgie
authors.forename: Andrew
authors.initials: A
authors.lastname: Farb
authors.forename: Deena
authors.initials: D
authors.lastname: Weber
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001158:Arteries / Q000473:pathology; D002114:Calcinosis / Q000473:pathology; D003324:Coronary Artery Disease / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D004547:Elastic Tissue / Q000473:pathology; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors; D017540:Tunica Media / Q000473:pathology