Which pathologic findings are characteristic of healed plaque rupture in atherosclerosis?

Updated: Dec 30, 2019
  • Author: Elena R Ladich, MD; Chief Editor: Allen Patrick Burke, MD  more...
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Answer

Morphologic studies suggest that plaque progression beyond 40-50% cross-sectional luminal narrowing occurs secondary to repeated ruptures. Ruptured lesions with healed repair sites, namely, healed plaque ruptures (HPRs) as shown by Mann and Davies, are easily detected microscopically by the identification of breaks in the fibrous cap with an overlying repair reaction consisting of proteoglycans and/or collagen, depending on the phase of healing. [24] Early-healed lesions are rich in proteoglycan, which are eventually replaced by type I collagen.

The prevalence of silent ruptures in the clinical population is unknown. Few angiographic studies have demonstrated plaque progression, and short-term studies have suggested that thrombosis is the likely cause. Mann and Davies showed that the frequency of healed plaque ruptures increases along with lumen narrowing. [24] In plaques with 0-20% diameter stenosis, the incidence of healed plaque ruptures was 16%; in lesions with 21-50% stenosis, the incidence was 19%; and in plaques with >50% narrowing, the incidence was 73%. [24]

The authors have shown a high frequency of healed plaque ruptures in the coronary arteries from patients dying suddenly with severe coronary disease. [25] The percentage of cross-sectional luminal narrowing was dependent on the number of healed repair sites.


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