Which pathologic findings are characteristic of intraplaque hemorrhage in atherosclerosis?

Updated: Dec 30, 2019
  • Author: Elena R Ladich, MD; Chief Editor: Allen Patrick Burke, MD  more...
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Data from the authors' laboratory provide evidence that repeat intraplaque hemorrhage is a contributing factor to necrotic core expansion, as red blood cells are a rich source of free cholesterol, which is an important constituent of ruptured plaques. [22] The red blood cells are enriched with lipids constituting 40% of their weight and free cholesterol content within membranes exceeding all other cell types. The expression of glycophorin-A (a protein exclusive to red blood cell membranes) within the necrotic cores of advanced coronary atheroma is strongly positive, whereas its presence in plaques with early necrosis or pathologic intimal thickening remains absence or low.

Intraplaque hemorrhage likely occurs from leaky vasa vasorum that infiltrate the plaque as the lesion thickness increases. The authors have reported that microvessel density is increased in advanced plaques compared with early plaques. Microvessels in normal and atherosclerotic arteries are thin-walled, with compromised structural integrity characterized by poor endothelial junctions. [23] Therefore, intraplaque hemorrhage together with the death of macrophages in the setting of defective phagocytic clearance of apoptotic cells is thought to contribute to the development of necrotic core in advance stage plaques.

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