Clinical studyAssociation between complex coronary artery stenosis and unstable angina and the extent of plaque inflammation☆
Section snippets
Study patients
Directional coronary atherectomy for culprit coronary lesions suitable for coronary atherectomy (in general, proximal and eccentric lesions) was performed in 79 consecutive patients with unstable (Braunwald class I to III, n = 46) (8) or stable (Canadian Cardiovascular Society class I to III, n = 33) (9) angina. The coronary lesion was identified as the “culprit lesion” based on clinical and electrocardiographic findings.
Qualitative and quantitative assessment of coronary stenosis
Qualitative assessment of coronary lesions was performed following the
Results
The mean (± SD) age of the predominantly male (76%) sample was 59 ± 11 years (Table 1).
Discussion
Several mechanical and biological factors affect the clinical presentation of coronary artery disease. Complex coronary lesions are associated with reduced coronary flow and tend to manifest clinically as unstable angina (11). Culprit lesions in patients with unstable angina contain large numbers of macrophages and T lymphocytes compared with those in patients with stable angina 6, 7. These inflammatory cells may cause deleterious effects in the shoulder region of a lipid-rich plaque, the site
Acknowledgements
The authors acknowledge D. Kearney, M. I. Schenker, and W. P. Meun for preparing the manuscript, and the technical and nursing staff of the Cardiac Catheterization Laboratory (M. G. H. Meesterman) for their skilled assistance.
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Topography of immune cell infiltration in different stages of coronary atherosclerosis revealed by multiplex immunohistochemistry
2023, IJC Heart and VasculatureCitation Excerpt :Most studies on human CAD investigated culprit regions, in which presence of macrophages is described [8,10,28,38]. Higher numbers of macrophages were found in culprit lesions compared to non-culprit, and in patients with myocardial infarction or instable angina compared to stable angina patients [8,10,28,38]. A potential role for non-M2 macrophages in disease progression is the release of MMPs leading to plaque destabilization.
Circulating retinol binding protein 4 is associated with coronary lesion severity of patients with coronary artery disease
2015, AtherosclerosisCitation Excerpt :Although the pathophysiological mechanism by which RBP4 increases cardiovascular risk is still unclear, inflammation and metabolic disorders seem to be essential components to be implicated in the pathogenesis of coronary plaque vulnerability [19]. RBP4 has been shown to directly contribute to inflammatory response in endothelial cells [33] and therefore accelerate or modify a complex and chronic inflammatory vascular process, which is associated with angiographic grading of coronary lesion complexity and unstable angina [34]. Additionally, elevated RBP4 levels impairs insulin signaling in muscle, contributing to the pathogenesis of insulin resistance and type 2 diabetes [9], which had been documented to correlate highly with coronary plaque vulnerability [35].
Association of plasma leptin levels and complexity of the culprit lesion in patients with unstable angina
2008, International Journal of CardiologyCitation Excerpt :These cytokines alone or in conjunction contribute to the local inflammatory response and may have great impact on plaque formation and progression on the other hand anti-inflammatory cytokines like IL-4 and IL-10 play important role in balancing the inflammatory response. An increased presence of proinflammatory cells has been observed in UA patients with complex coronary lesions as compared to patients having simple types of lesions [11]. Clinical studies have shown the presence of these angiographically visible complex lesions as having a multitude of adverse outcomes, with the possibility that these types of lesions might predict myocardial infarction [12].
Angiographic and clinical characteristics associated with the removable plaque components by means of thrombectomy catheters in patients with myocardial infarction
2007, Cardiovascular Revascularization MedicineCitation Excerpt :Several studies have suggested that lesion morphology is correlated with the clinical status and prognosis of a patient. For example, a previous study revealed that the extent of atherosclerotic plaque inflammation is associated with angiographic grading of coronary lesion complexity [30]. In another study, there was a difference in plaque distribution: lumen location by IVUS was significantly more eccentric in ruptured than in nonruptured plaques [31].
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This study was sponsored by the Netherlands Heart Foundation (grants D96.020 and 2000.090).