title: Increased Vascularization in the Vulnerable Upstream Regions of Both Early and Advanced Human Carotid Atherosclerosis.
abstract: BACKGROUND
  Vascularization of atherosclerotic plaques has been linked to plaque vulnerability. The aim of this study was to test if the vascularization was increased in upstream regions of early atherosclerotic carotid plaques and also to test if the same pattern of vascularization was seen in complicated, symptomatic plaques.
  
  
  METHODS
  We enrolled 45 subjects with early atherosclerotic lesions for contrast enhanced ultrasound and evaluated the percentage of plaque area in a longitudinal ultrasound section which contained contrast agent. Contrast-agent uptake was evaluated in both the upstream and downstream regions of the plaque. We also collected carotid endarterectomy specimens from 56 subjects and upstream and downstream regions were localized using magnetic resonance angiography and analyzed using histopathology and immunohistochemistry.
  
  
  RESULTS
  Vascularization was increased in the upstream regions of early carotid plaques compared with downstream regions (30% vs. 23%, p = 0.033). Vascularization was also increased in the upstream regions of advanced atherosclerotic lesions compared with downstream regions (4.6 vs. 1.4 vessels/mm2, p = 0.001) and was associated with intra-plaque hemorrhage and inflammation.
  
  
  CONCLUSIONS
  Vascularization is increased in the upstream regions of both early and advanced plaques and is in advanced lesions mainly driven by inflammation.
authors.affiliation: The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.|Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ola
authors.identifier: http://orcid.org/0000-0002-8639-6928
authors.initials: O
authors.lastname: Hjelmgren
authors.affiliation: The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Gellerman
authors.affiliation: The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Josefin
authors.initials: J
authors.lastname: Kjelldahl
authors.affiliation: The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Lindahl
authors.affiliation: The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.|Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Göran M L
authors.initials: GM
authors.lastname: Bergström
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000473:pathology; D002340:Carotid Artery Diseases / Q000473:pathology*; D016893:Carotid Stenosis / Q000473:pathology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D009389:Neovascularization, Pathologic / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D013927:Thrombosis / Q000503:physiopathology; D014463:Ultrasonography