From the Department of Neurology, Heinrich Heine University,
Düsseldorf, Germany.
Background and Purpose—Inflammatory
mechanisms have been implicated in the pathogenesis of
atherosclerosis. In this study, we investigated whether
the extent of inflammatory infiltration in high-grade stenoses
of the internal carotid artery (ICA) correlates to clinical features of
plaque destabilization.
Methods—Endarterectomy specimens from 37
consecutive patients undergoing surgery for high-grade ICA
stenosis were stained immunocytochemically for
macrophages (CD68) and T cells (CD3). The staining was
quantified by planimetry of immunostained areas
(CD68) or counting individual cells (CD3). Clinical evidence of plaque
instability was provided by the preoperative assessment of recent
ischemic symptoms attributable to the stenosis and of
the occurrence of cerebral microembolism in transcranial
Doppler ultrasound monitoring of the ipsilateral middle cerebral
artery.
Results—The percentage of macrophage-rich areas and
number of T cells per mm2 section area were larger in
recently symptomatic patients than in
asymptomatic patients (macrophages: 18±10% versus
11±4%, P=0.005; T cells: 71.2±34.4 versus
40.5±31.4 mm2, P=0.005). The presence
of microembolism was associated with an increase in
macrophage-rich areas (P=0.011).
Macrophage (19±10% versus 9±3%, P=0.0009)
and T cell (71.5±39.0 versus 46.4±22 mm2,
P=0.045) infiltration were more pronounced in
predominantly atheromatous than in fibrous plaques, but
did not correlate significantly to the presence of surface ulceration
or luminal thrombosis.
Conclusions—Our data suggest a role of plaque-infiltrating
macrophages and T cells in the clinical destabilization of
high-grade ICA stenoses. Inflammatory mechanisms may be a
therapeutic target in patients with symptomatic ICA
disease.
© 1998 American Heart Association, Inc.
Original Contributions
Inflammation in High-Grade Carotid Stenosis
A Possible Role for Macrophages and T Cells in Plaque Destabilization
Key Words: atherosclerosis • carotid arteries • cerebrovascular disorders • immunohistochemistry • leukocytes
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