Thin cap atheromas characterized by large necrotic cores, fibrous caps < 65 microns, and numerous macrophages indicate plaque instability and vulnerability to rupture.
Identifying the morphologic features of thin-cap fibroatheromas, such as cap thickness < 65 microns and large necrotic cores, is crucial for understanding plaque vulnerability and developing targeted stabilizing therapies.
Thin cap atheroma is the precursor of plaque rupture, which accounts for a majority of coronary thrombi. The morphologic features of thin cap atheromas that predict rupture are unknown, but we know from studies of ruptured plaques that large necrotic cores, fibrous cap < 65 microns and numerous macrophages within the cap likely indicate instability. There is some evidence that a speckled pattern of calcification is associated with vulnerability to rupture. There are usually multiple thin cap atheroma in the hearts of patients dying with acute plaque rupture, as well as multiple fibroatheromas with intraplaque hemorrhage. Targeted therapy for the purpose of stabilizing coronary lesions that are prone to rupture is a major future goal of the interventionist.
Virmani et al. (Fri,) conducted a review in Thin-cap fibroatheroma. Thin cap atheromas characterized by large necrotic cores, fibrous caps < 65 microns, and numerous macrophages indicate plaque instability and vulnerability to rupture.
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