The document summarizes a study examining the prevalence of inflammatory cells in non-ruptured atherosclerotic plaques. The study found that moderate or heavy staining for macrophages was present in 45% of femoral artery cross-sections and 84% of femoral arteries had at least one cross-section with moderate or heavy inflammation. Additionally, there was no relationship found between the degree of inflammation in the left versus right coronary artery within individuals. The conclusion is that the presence of inflammatory cells is common in non-ruptured plaques and the level of local inflammation does not predict inflammation in other arteries.

1. Editorial Slides
VP Watch, March 13, 2002, Volume 2, Issue 10
The prevalence of inflammatory cells in non
ruptured atherosclerotic plaques
By: Gerard Pasterkamp, M.D., Ph.D.
Inter University Cardiology Institute of the Netherlands

2. Background
 Plaque rupture and subsequent plaque
thrombosis is found to be associated with
the presence of inflammatory cells. 1-3

3. Plaque Rupture

4. Question
Is the presence of inflammatory cells:
A- Specific for plaque rupture or
B- A commonly observed phenomenon in
atherosclerotic lesions?
What is the prevalence of moderate/heavy local
inflammation in non ruptured atherosclerotic lesions?

5.  Atherosclerotic femoral (n=50) and coronary
arteries (n=74) from patients that did not die of
cardiovascular disease.
 In each artery, 4-6 non ruptured cross-sections
revealing atherosclerosis were studied for the
presence of macrophages (CD 68) and T-
lymphocytes (CD45RO).
Post Mortem Study:

6. Positive Negative

7. Positive Negative

8. Femoral Artery
 45% of all cross-sections revealed
moderate or heavy staining for
macrophages in the cap or shoulder of
non ruptured plaques.

9. Question
If one would randomly stain 5-6 cross-sections obtained
from an atherosclerotic artery for inflammatory cells,
how often would at least one cross-section reveal
moderate to heavy staining for inflammatory cells?

10. Positive Negative

11. Positive Negative

12. Femoral Arteries
In 84% of all femoral arteries at least one cross-section
revealed moderate or haevy staining for macrophages
or T-lymphocytes in cap or shoulder of the non
ruptured athertosclerotic plaque.

13. Questions
If one would find many cross-sections with
inflammation in one coronary artery: would that be
predictive for the occurrence of plaque inflammation
in another coronary artery?
Right and left coronary arteries were compared within
the individual (next slide)

14. No relation was observed between the degree of staining
for inflammatory cells between the left and right
coronary artery.
- = No Staining, + = Moderate Staining, ++ = Heavy Staining
Left coronary artery
Right coronary artery - + ++
- 3 4 0
+ 2 11 2
++ 0 3 0

15. Conclusion:
1. The presence of inflammatory cells is a
common phenomenon in non ruptured
atherosclerotic lesions.
2. The degree of local inflammation is locally
determined and has no/low predictive value
for the presence of inflammation in other
arteries.

16. Discussion
I. Considering these results: what is the predictive
value of local inflammation for the occurrence of
plaque rupture?
II. Visualization of the vulnerable plaque when
inflammation is used as marker:
- Specificity for local plaque rupture or
predictive value for
plaque rupture may be disappointing.

17. Suggestion:
VP.org Editorial Suggestion:
- Please email your thoughts to:
Discussion-Group@VP.org or DG@VP.org

18. 1. Davies et al. Br Heart J 1985;53:363-373
2. Van der Wal et al. Circulation 1994;89:36-44
3. Moreno et al. Circulation 1994;90:775-778
4. Pasterkamp et al. ATVB 1999, Vink et al JACC 2001
References