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Differences in lesion severity and cellular composition between in vivo assessed upstream and downstream sides of human symptomatic carotid atherosclerotic plaques

Journal article
Authors Björn Fagerberg
Mikael Ryndel
Josefin Kjelldahl
Levent Akyürek
Lars Rosengren
Lars Karlström
Göran Bergström
Fredrik J. Olson
Published in Journal of Vascular Surgery
Volume 47
Issue 3
Pages 221-230
ISSN 1423-0135
Publication year 2010
Published at Wallenberg Laboratory
Institute of Neuroscience and Physiology
Institute of Biomedicine
Institute of Medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 221-230
Language en
Keywords atherosclerosis, regional blood flow, magnetic resonance, carotid artery, stenosis
Subject categories Cell and Molecular Biology


Background: The heterogeneous structure of carotid atherosclerotic plaques may be better understood if it is related to blood flow variations, influencing gene expression and cellular functions. Upstream of the maximum stenosis there is laminar blood flow and high shear stress, downstream there is turbulence and low shear stress. We studied if these variations were associated with differences in plaque morphology and composition between sites located up- and downstream of the maximum stenosis in symptomatic carotid plaques. Methods: Patients with symptomatic carotid stenosis were examined with magnetic resonance angiography to localize the maximum stenosis in-vivo, prior to endarterectomy. In 41 endarterectomized specimens, transverse tissue sections prepared up- and downstream of the maximum stenosis were compared using histopathology and immunohistochemistry. Results: The location of maximum stenosis relative the carotid bifurcation varied considerably between plaques. Compared with the downstream side, the upstream side of the stenosis had higher incidence of severe lesions with cap rupture and intraplaque hemorrhage, more macrophages, less smooth muscle cells and more collagen. Conclusions: The up- and downstream sides of symptomatic carotid plaques differed in plaque morphology and composition. This implies that the intraplaque location of sampling sites may be a confounding factor in studies of atherosclerotic plaques.

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