Dilated microvessel with endothelial cell proliferation involves intraplaque hemorrhage in unstable carotid plaque
Dilated microvessel with endothelial cell proliferation involves intraplaque hemorrhage in unstable carotid plaque
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DOI：
10.1007/s00701-020-04595-0
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发表时间：
2020-09
影响因子：
2.4
通讯作者：
D. Kashiwazaki;Shusuke Yamamoto;N. Akioka;E. Hori;T. Shibata;N. Kuwayama;K. Noguchi;S. Kuroda
中科院分区：
文献类型：
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作者：
D. Kashiwazaki;Shusuke Yamamoto;N. Akioka;E. Hori;T. Shibata;N. Kuwayama;K. Noguchi;S. Kuroda
BackgroundThe purpose of the present study was to clarify endothelial cell（EC）proliferation in intra斑块内微血管in vulnerable plaque and impact on clinical outcomes.MethodsThe present study included 76 patients who experienced carotid endarterectomy.根据症状将患者分为三组：无症状组、无复发缺血事件的症状组和有复发缺血事件的症状组。进行磁共振斑块成像和手术标本进行免疫组化分析。CD 31+微血管，Ki 67+和CD 105+内皮细胞在颈动脉斑块的数量进行了量化，作为测量的最大CD 31+微血管diameter.ResultsMR斑块成像产生了41例（54.0%）诊断斑块斑块内出血（IPH），14例（18.4%）诊断纤维斑块，和21例（27.6%）诊断为富含脂质斑块。纤维斑块、富脂斑块和IPH斑块微血管最大直径分别为12.7 ± 4.1 μm、31.3 ± 9.3 μm和56.4 ± 10.0 μm（P < 0.01）。9.6%的IPH斑块中可见扩张的微血管（>40 μm），而富脂斑块中仅为2.8%，纤维斑块中为0%（p< 0.01）。Ki 67 +/CD 31 + EC在2.8 ± 1.2%的纤维斑块、9.6 ± 6.9%的富脂斑块和19.5 ± 5.9%的IPH斑块中被鉴定（p< 0.01）。微血管最大直径无症状组为17.1 ± 8.7 μm，有症状无复发组为32.3 ± 10.8 μm，有症状复发组为55.2 ± 13.2 μm（P< 0.01）。此外，扩张的微血管可能与缺血事件的临床发作和复发有关。本研究的目的是阐明易损斑块中斑块内微血管EC增殖的特征及其对临床结果的影响，重点是扩张的斑块内微血管。
BackgroundThe purpose of the present study was to clarify the characteristics of endothelial cell (EC) proliferation in intraplaque microvessels in vulnerable plaques and impact on clinical results.MethodsThe present study included 76 patients who underwent carotid endarterectomy. Patients were classified into three groups based on their symptoms: asymptomatic, symptomatic without recurrent ischemic event, and symptomatic with recurrent ischemic event. MR plaque imaging was performed and surgical specimens underwent immunohistochemical analysis. The number of CD31+microvessels, and Ki67+and CD105+ECs in the carotid plaques was quantified, as measurements of maximum CD31+microvessel diameter.ResultsMR plaque imaging yielded 41 subjects (54.0%) diagnosed with plaque with intraplaque hemorrhage (IPH), 14 subjects (18.4%) diagnosed with fibrous plaques, and 21 (27.6%) subjects diagnosed with lipid-rich plaques. The average largest diameter of microvessel in fibrous plaques, lipid-rich plaques, and plaque with IPH was 12.7 ± 4.1 μm, 31.3 ± 9.3 μm, and 56.4 ± 10.0 μm, respectively (p < 0.01). Dilated microvessels (>40 μm) were observed in 9.6% of plaques with IPH but only in 2.8% of lipid-rich plaques and 0% of fibrous plaques (p< 0.01). Ki67+/CD31+ECs were identified in 2.8 ± 1.2% of fibrous plaques, 9.6 ± 6.9% of lipid-rich plaques, and in 19.5 ± 5.9% of plaques with IPH (p< 0.01). The average largest diameter of microvessels in the asymptomatic group was 17.1 ± 8.7 μm, 32.3 ± 10.8 μm in the symptomatic without recurrence group, and 55.2 ± 13.2 μm in the symptomatic with recurrence group (p< 0.01).ConclusionDilated microvessels with proliferative ECs may play a key role in IPH pathogenesis. Furthermore, dilated microvessels are likely related to clinical onset and the recurrence of ischemic events. The purpose of the present study was to clarify the characteristics of EC proliferation in intraplaque microvessels in vulnerable plaques and their impact on clinical results, focusing on dilated intraplaque microvessels.