Atherosclerosis
Epidemiology:
- Risk increases
with age
- M > F
Common sites:
- abdominal aorta
> thoracic aorta
- ostia of major branches
- coronaries
- popliteals
- internal carotid
- circle of Willis
Gross features:
- atheromas and atheromatous
plaques (fibrofatty plaques)
- soft, yellow, grumous core (lipid)
- firm, white
fibrous cap
- eccentrically
located
- patchy and
variable along the length of the vessel
Histologic features:
- intimal thickening
- lipid accumulation
- 3 components:
- cells – smooth
muscle cells, macrophages, leukocytes
- ECM – collagen,
elastic fibres, proteoglycans
- Lipid –
intracellular and extracellular
- Superficial
fibrous cap:
- Smooth muscle
cells and dense ECM
- “shoulder” –
beneath and to the side of the cap
- cellular area –
macrophages, smooth muscle cells, T cells
- necrotic core:
- lipid
(cholesterol and cholesterol esters), cholesterol clefts
- cellular debris
- foam cells
- fibrin
- thrombus
- plasma proteins
- calcification
- neovascular periphery:
- proliferating
small blood vessels
- type I (initial)
lesion:
- isolated foamy
macrophages
- type II (fatty
streak) lesion:
- foamy
macrophages (lipid-filled) in the intima
- T cells
- type III (intermediate) lesion:
- type IV (atheroma) lesion:
- type V (fibroatheroma) lesion:
- type VI
(complicated) lesion:
- rupture,
ulceration, or erosion of the luminal surface
- thrombus
formation superimposed
- hemorrhage into
a plaque
- atrophy of underlying
media with loss of elastic tissue
- aneurismal dilation
/ potential rupture
Immunophenotype:
Marker:
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Sensitivity:
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Specificity:
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Molecular features:
Other features:
- risk factors:
- age
- sex
- family history
- hypercholesterolemia
- lhypertension
- smoking
- diabetes
- homocystinuria
References: