title: Arterial neovascularization and inflammation in vulnerable patients: early and late signs of symptomatic atherosclerosis.
abstract: BACKGROUND
  Atherosclerosis is complicated by cardiovascular events such as myocardial infarction, stroke, or peripheral arterial occlusive disease. Inflammation and pathological neovascularization are thought to precipitate plaque rupture or erosion, both causes of arterial thrombosis and cardiovascular events. We tested the hypothesis that arterial inflammation and angiogenic events are increased throughout the arterial tree in vulnerable patients, ie, in patients who suffered from cardiovascular events, compared with patients who never suffered from complications of atherosclerosis.
  
  
  RESULTS
  In a postmortem study, we quantified the inflammatory infiltrate and microvascular network in the arterial wall of iliac, carotid, and renal arteries. Tissue microarray technology was adapted to investigate full-thickness arterial sectors. We compared 22 patients with symptomatic atherosclerosis with 27 patients who never had suffered from any cardiovascular event. The absolute intimal macrophage content was 2- to 4-fold higher in vulnerable patients at all 3 arterial sites analyzed (P<0.05). Patients with symptomatic atherosclerosis had a denser network of vasa vasorum than patients with asymptomatic disease (33+/-2 versus 25+/-2 adventitial microvessels per 1 mm2; P=0.008). Hyperplasia of vasa vasorum was an early and macrophage infiltration was a late sign of symptomatic atherosclerosis.
  
  
  CONCLUSIONS
  High intimal macrophage content and a hyperplastic network of vasa vasorum characterize vulnerable patients suffering from symptomatic atherosclerosis. These changes are uniformly present in different arterial beds and support the concept of symptomatic atherosclerosis as a panarterial disease.
authors.affiliation: Department of Medicine, University Hospital Bruderholz, Bruderholz, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fleiner
authors.forename: Marco
authors.initials: M
authors.lastname: Kummer
authors.forename: Martina
authors.initials: M
authors.lastname: Mirlacher
authors.forename: Guido
authors.initials: G
authors.lastname: Sauter
authors.forename: Gieri
authors.initials: G
authors.lastname: Cathomas
authors.forename: Reto
authors.initials: R
authors.lastname: Krapf
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Biedermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007083:Iliac Artery / Q000473:pathology*; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology; D014651:Vasa Vasorum / Q000473:pathology*; D014657:Vasculitis / Q000473:pathology*