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(Stroke. 2008;39:1029.)
© 2008 American Heart Association, Inc.

Research Letters

Histological Characterization of Restenotic Carotid Plaques in Relation to Recurrence Interval and Clinical Presentation

A Cohort Study

Willem E. Hellings, MD; Frans L. Moll, MD, PhD; Jean-Paul P.M. de Vries, MD, PhD; Peter de Bruin, MD, PhD; Dominique P.V. de Kleijn, PhD Gerard Pasterkamp, MD, PhD

From the Experimental Cardiology Laboratory (W.E.H., D.P.V.d.K., G.P.), University Medical Center, Utrecht, The Netherlands; the Department of Vascular Surgery (W.E.H., F.L.M.), University Medical Center, Utrecht, The Netherlands; the Department of Vascular Surgery (J.-P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands; and the Department of Pathology (P.d.B.), St. Antonius Hospital, Nieuwegein, The Netherlands.

Correspondence to Willem E. Hellings MD, Experimental Cardiology Laboratory, University Medical Center Utrecht, Heidelberglaan 100, Suite G02.523, 3584CX Utrecht, The Netherlands. E-mail w.e.hellings{at}umcutrecht.nl

Abstract

Backgrounds and Purpose— Restenosis is an important complication after carotid endarterectomy, but little is known about plaque composition in early versus late restenosis and which plaque characteristics are associated with symptomatic clinical presentation of restenotic lesions.

Methods— Endarterectomy specimens of 822 consecutive patients undergoing carotid endarterectomy (33 restenotic; 789 primary) were subjected to histological examination for the presence of macrophages, smooth muscle cells, collagen, calcifications, luminal thrombus, intraplaque bleeding and lipid core size.

Results— Early restenotic plaques showed marked accumulation of smooth muscle cells and fibrous tissue, whereas late restenotic plaques demonstrated increased macrophage infiltration, calcification and lipid core (P trend <0.05), resembling primary plaques. Patients with symptomatic restenosis had plaques with higher macrophage infiltration (P=0.01) and a larger lipid core (P=0.02) than asymptomatic patients, independent of recurrence interval.

Conclusions— Restenosis occurring >5 years after primary carotid endarterectomy resembles primary plaques. Symptomatic presentation of restenotic lesions is independently associated with an unstable plaque phenotype.

Key Words: atherosclerotic plaque • carotid endarterectomy • cerebrovascular symptoms • histology • restenosis