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• W2098177557 abstract "A ngiographic and necropsy studies have suggested a direct pathogenetic relation among rupture of a coronary arterial atherosclerotic plaque, coronary thrombus formation, and acute myocardial infarction (AMI).‘-” However, the local pathophysiologic factor or factors responsible for the initiation of plaque rupture have not been identified, Suggestions have included hemorrhage into a plaque after injury to vasa vasora; mechanical compression associated with coronary spasm; increased intraluminal arterial pressure; and circumferential tensile stress on the “fibrous cap” of the plaque. In this article we summarize the evidence for and against each of these theories and present the case for hemodynamic (rheologic) shear forces as a factor in the pathogenesis of plaque rupture. Rupture of vasa vasora: Damage to small vascular channels within atherosclerotic plaques has been suggested by a number of investigators to be a source of plaque hemorrhage,12-15 but none has shown how this might result in plaque rupture. Extravasation of erythrocytes from injury to intraplaque vascular channels is known to occur in large plaques, but this has been distinguished from hemorrhage associated with plaque rupture by the absence in the former of associated fibrin and platelets. I6 Moreover, Constantinides,17 in an analysis of serial sections of 17 cases of fatal coronary thrombosis, showed that the associated plaque hemorrhage could always be traced to an entry of blood from the lumen through the same crack in the plaque. Thus, although intraplaque vascular channels are seen often, it is our experience that they are not seen within lipid-rich pultaceous debris, and there is no evidence that such channels are associated with plaque hemorrhage which accompanies rupture of a coronary atherosclerotic plaque. Plaque compression by coronary vasospasm: Vasoconstriction or spasm has been proposed as a cause of rupture of an atherosclerotic plaque,18-20 but can vasospasm occur in severely narrowed coronary arteries? The dominant histopathologic component of coronary atherosclerotic plaques is fibrous tissue, and, when the luminal narrowing is severe, the underlying media is often severely attenuated. 21,22 Nevertheless, angiographic" @default.
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• W2098177557 date "1990-12-01" @default.
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• W2098177557 title "Hemodynamic shear force in rupture of coronary arterial atherosclerotic plaques" @default.
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• W2098177557 doi "https://doi.org/10.1016/0002-9149(90)91170-b" @default.
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