How is plaque rupture differentiated from plaque erosion in atherosclerosis?

Updated: Dec 30, 2019
  • Author: Elena R Ladich, MD; Chief Editor: Allen Patrick Burke, MD  more...
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Both clinical and morphologic differences are widely apparent between plaque rupture and erosion. Beginning with age, patients with plaque rupture tend to be significantly older (53 ± 10 y) than those with erosion (44 ± 7 y) (P< 0.02). Survival is also a critical factor, because an estimation of fatal ruptures in the fifth decade of life is 17 per 100,000 per year compared with 6 per 100,000 for plaque erosion.

Although the relationship between risk factors and culprit plaques is similar between women and men, the proportion of women younger than the age of 50 years dying suddenly with plaque erosion is remarkably higher. Plaque burden expressed as the percentage of cross-sectional area stenosis excluding the thrombus is greater in plaque ruptures (78 ± 12%) than erosions (70 ± 11%) (P< 0.03), whereas eccentric plaques are more common in erosions. Unlike the prominent fibrous cap inflammation described in ruptures, eroded surfaces contain fewer macrophages and T lymphocytes. Taken together, eroded plaques tend to be eccentric lesions rich in smooth muscle cells and proteoglycans with very little inflammation or calcification.

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