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van Dijk RA, Kleemann R, Schaapherder AF, van den Bogaerdt A, Hedin U, Matic L, Lindeman JH. Validating human and mouse tissues commonly used in atherosclerosis research with coronary and aortic reference tissue: similarities but profound differences in disease initiation and plaque stability. JVS Vasc Sci 2023; 4:100118. [PMID: 37810738 PMCID: PMC10551657 DOI: 10.1016/j.jvssci.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/14/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Characterization of the atherosclerotic process fully relies on histological evaluation and staging through a consensus grading system. So far, a head-to-head comparison of atherosclerotic process in experimental models and tissue resources commonly applied in atherosclerosis research with the actual human atherosclerotic process is missing. Material and Methods Aspects of the atherosclerotic process present in established murine atherosclerosis models and human carotid endarterectomy specimen were systematically graded using the modified American Heart Association histological classification (Virmani classification). Aspects were aligned with the atherosclerotic process observed in human coronary artery and aortic atherosclerosis reference tissues that were available through biobanks based on human tissue/organ donor material. Results Apart from absent intraplaque hemorrhages in aortic lesions, the histological characteristics of the different stages of human coronary and aortic atherosclerosis are similar. Carotid endarterectomy samples all represent end-stage "fibrous calcified plaque" lesions, although secondary, progressive, and vulnerable lesions with gross morphologies similar to coronary/aortic lesions occasionally present along the primary lesions. For the murine lesions, clear histological parallels were observed for the intermediate lesion types ("pathological intimal thickening," and "early fibroatheroma"). However, none of the murine lesions studied progressed to an equivalent of late fibroatheroma or beyond. Notable contrasts were observed for disease initiation: whereas disease initiation in humans is characterized by a mesenchymal cell influx in the intima, the earliest murine lesions are exclusively intimal, with subendothelial accumulation foam cells. A mesenchymal (and medial) response are absent. In fact, it is concluded that the stage of "adaptive intimal thickening" is absent in all mouse models included in this study. Conclusions The Virmani classification for coronary atherosclerosis can be applied for systematically grading experimental and clinical atherosclerosis. Application of this histological grading tool shows clear parallels for intermediate human and murine atherosclerotic lesions. However, clear contrasts are observed for disease initiation, and late stage atherosclerotic lesions. Carotid endarterectomy all represent end-stage fibrous calcified plaque lesions, although secondary earlier lesions may present in a subset of samples.
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Affiliation(s)
- Rogier A. van Dijk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Kleemann
- The Netherlands Organization for Applied Scientific Research (TNO), Department of Metabolic Health Research, TNO Metabolic Health Research, Leiden, The Netherlands
| | | | | | - Ulf Hedin
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Ljubica Matic
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Jan H.N. Lindeman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Vos A, Houben IB, Celeng C, Takx RAP, Isgum I, Mali WPTM, Vink A, de Jong PA. Aortic calcification: A postmortem CT validation study in a middle-aged population. Eur J Radiol 2023; 159:110687. [PMID: 36610325 DOI: 10.1016/j.ejrad.2023.110687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Computed tomography (CT)-detected aortic calcification is strongly associated with aortic stiffness and is an accurate predictor of cardiovascular and all-cause mortality and cognitive decline. Some previous pathologic studies have shown calcium accumulation in the medial layer of the vessel wall, while others have suggested localisation in the atherosclerotic intimal layer. OBJECTIVES The aim of this study was to histologically validate CT findings of aortic calcification for detectability and location in the aortic wall. METHODS We acquired postmortem CT images and collected 170 aortic tissue samples from five different locations in the thoracic and abdominal aorta of 40 individuals who underwent autopsy. Microscopic slides were stained with haematoxylin and eosin and elastic van Gieson stain. Calcified lesions were characterised and calcifications were manually annotated in the intima and media. The presence and morphology of calcifications were scored on CT images. RESULTS The mean age of the autopsied individuals was 63 years, and 28 % died of cardiovascular disease. Calcifications were present in 74/170 (44 %) samples. Calcification was more common in the abdominal aorta than in the thoracic aorta. In all samples with calcifications, 99 % were located in the intimal layer. Only 16/170 samples had a small amount of medial arterial calcification. The histological results showed an 85 % concordance for the presence or absence of CT calcifications. There was complete inter-method agreement for annularity of calcifications in 68 % of the samples (linear weighted kappa 0.68 (95 %CI 0.60-0.77). CONCLUSIONS Aortic calcifications visible on CT are located in the intimal layer of the abdominal aorta wall, at least in aortas that are not aneurysmatic or dissected. The presence and annularity of these calcifications can be reliably determined by CT.
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Affiliation(s)
- Annelotte Vos
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Ignas B Houben
- University Medical Center Utrecht and Utrecht University, Department of Vascular Surgery, The Netherlands; Frankel Cardiovascular Center, University of Michigan, Department of Cardiac Surgery, United States
| | - Csilla Celeng
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Richard A P Takx
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Ivana Isgum
- Amsterdam University Medical Centers, The Netherlands
| | - Willem P T M Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Aryan Vink
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Pim A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands.
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3
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Vos A, Vink A, Kockelkoren R, Takx RAP, Celeng C, Mali WPTM, Isgum I, Bleys RLAW, de Jong PA. Radiography and Computed Tomography Detection of Intimal and Medial Calcifications in Leg Arteries in Comparison to Histology. J Pers Med 2022; 12:jpm12050711. [PMID: 35629134 PMCID: PMC9144714 DOI: 10.3390/jpm12050711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Calcifications are common in the tunica intima and tunica media of leg arteries. There is growing interest in medial arterial calcifications, as they may be modifiable with treatment. We aimed to investigate radiography and computed tomography (CT) for the detection and characterization of both types of arterial calcification in leg arteries in relation to histology. In a postmortem study we therefore investigated 24 popliteal and 24 tibial arteries. The reference standard was presence of arterial calcification and the dominance of intimal or medial calcification on histology. Radiographs and CT scans were scored for presence of calcification and for dominant intimal or medial pattern based on prespecified criteria (annularity, thickness, continuity). Both radiography and CT detected 87% of histologically proven calcifications but missed mild calcifications in 13%. When only the arteries with detected calcifications were included, a moderate agreement was observed on intimal/medial location of calcifications between histology and radiography (correct in 19/24 arteries (79%); Kappa 0.58) or CT (correct in 33/46 arterial segments (72%); Kappa 0.48). With both modalities there was a slight tendency to classify intimal calcifications as being located in the media and to miss media calcification. Our study demonstrates the potential and limitations of both radiography and CT to detect and classify arterial calcifications in leg arteries.
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Affiliation(s)
- Annelotte Vos
- Department of Pathology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (A.V.); (A.V.)
- Department of Pathlogy, Meander Medical Center, 3800 BM Amersfoort, The Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (A.V.); (A.V.)
| | - Remko Kockelkoren
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Richard A. P. Takx
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Csilla Celeng
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Willem P. T. M. Mali
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
| | - Ivana Isgum
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Ronald L. A. W. Bleys
- Department of Anatomy, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands;
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands; (R.K.); (R.A.P.T.); (C.C.); (W.P.T.M.M.)
- Correspondence: ; Tel.: +31-88-7556689
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Abstract
Cardiovascular diseases caused by atherosclerosis do not typically manifest before middle age; however, the disease process begins early in life. Preclinical atherosclerosis can be quantified with imaging methods in healthy populations long before clinical manifestations present. Cohort studies have shown that childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure and tobacco smoking, are associated with adult preclinical atherosclerotic phenotypes. Importantly, these long-term effects are substantially reduced if the individual becomes free from the risk factor by adulthood. As participants in the cohorts continue to age and clinical end points accrue, the strongest evidence linking exposure to risk factors in early life with cardiovascular outcomes has begun to emerge. Although science has deciphered the natural course of atherosclerosis, discovered its causal risk factors and developed effective means to intervene, we are still faced with an ongoing global pandemic of atherosclerotic diseases. In general, atherosclerosis goes undetected for too long, and preventive measures, if initiated at all, are inadequate and/or come too late. In this Review, we give an overview of the available literature suggesting the importance of initiating the prevention of atherosclerosis in early life and provide a summary of the major paediatric programmes for the prevention of atherosclerotic disease. We also highlight the limitations of current knowledge and indicate areas for future research.
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Bruijn LE, van Stroe Gómez CG, Curci JA, Golledge J, Hamming JF, Jones GT, Lee R, Matic L, van Rhijn C, Vriens PW, Wågsäter D, Xu B, Yamanouchi D, Lindeman JH. A histopathological classification scheme for abdominal aortic aneurysm disease. JVS Vasc Sci 2021; 2:260-273. [PMID: 34825232 PMCID: PMC8605212 DOI: 10.1016/j.jvssci.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Two consensus histopathological classifications for thoracic aortic aneurysms (TAAs) and inflammatory aortic diseases have been issued to facilitate clinical decision-making and inter-study comparison. However, these consensus classifications do not specifically encompass abdominal aortic aneurysms (AAAs). Given its high prevalence and the existing profound pathophysiologic knowledge gaps, extension of the consensus classification scheme to AAAs would be highly instrumental. The aim of this study was to test the applicability of, and if necessary to adapt, the issued consensus classification schemes for AAAs. METHODS Seventy-two AAA anterolateral wall samples were collected during elective and emergency open aneurysm repair performed between 2002 and 2013. Histologic analysis (hematoxylin and eosin and Movat Pentachrome) and (semi-quantitative and qualitative) grading were performed in order to map the histological aspects of AAA. Immunohistochemistry was performed for visualization of aspects of the adaptive and innate immune system, and for a more detailed analysis of atherosclerotic lesions in AAA. RESULTS Because the existing consensus classification schemes do not adequately capture the aspects of AAA disease, an AAA-specific 11-point histopathological consensus classification was devised. Systematic application of this classification indicated several universal features for AAA (eg, [almost] complete elastolysis), but considerable variation for other aspects (eg, inflammation and atherosclerotic lesions). CONCLUSIONS This first multiparameter histopathological AAA consensus classification illustrates the sharp histological contrasts between thoracic and abdominal aneurysms. The value of the proposed scoring system for AAA disease is illustrated by its discriminatory capacity to identify samples from patients with a nonclassical (genetic) variant of AAA disease.
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Affiliation(s)
- Laura E. Bruijn
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Charid G. van Stroe Gómez
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - John A. Curci
- Section of Surgical Sciences, Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jaap F. Hamming
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Greg T. Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Regent Lee
- Nuffield Dept. of Surgical Sciences, University of Oxford, Headington, United Kingdom
| | - Ljubica Matic
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Connie van Rhijn
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Patrick W. Vriens
- Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Dick Wågsäter
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Baohui Xu
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Dai Yamanouchi
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc
| | - Jan H. Lindeman
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Assessment of Electrospun Pellethane-Based Scaffolds for Vascular Tissue Engineering. MATERIALS 2021; 14:ma14133678. [PMID: 34279249 PMCID: PMC8269885 DOI: 10.3390/ma14133678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
We examined the physicochemical properties and the biocompatibility and hemocompatibility of electrospun 3D matrices produced using polyurethane Pellethane 2363-80A (Pel-80A) blends Pel-80A with gelatin or/and bivalirudin. Two layers of vascular grafts of 1.8 mm in diameter were manufactured and studied for hemocompatibility ex vivo and functioning in the infrarenal position of Wistar rat abdominal aorta in vivo (n = 18). Expanded polytetrafluoroethylene (ePTFE) vascular grafts of similar diameter were implanted as a control (n = 18). Scaffolds produced from Pel-80A with Gel showed high stiffness with a long proportional limit and limited influence of wetting on mechanical characteristics. The electrospun matrices with gelatin have moderate capacity to support cell adhesion and proliferation (~30–47%), whereas vascular grafts with bivalirudin in the inner layer have good hemocompatibility ex vivo. The introduction of bivalirudin into grafts inhibited platelet adhesion and does not lead to a change hemolysis and D-dimers concentration. Study in vivo indicates the advantages of Pel-80A grafts over ePTFE in terms of graft occlusion, calcification level, and blood velocity after 6 months of implantation. The thickness of neointima in Pel-80A–based grafts stabilizes after three months (41.84 ± 20.21 µm) and does not increase until six months, demonstrating potential for long-term functioning without stenosis and as a suitable candidate for subsequent preclinical studies in large animals.
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Meester EJ, de Blois E, Krenning BJ, van der Steen AFW, Norenberg JP, van Gaalen K, Bernsen MR, de Jong M, van der Heiden K. Autoradiographical assessment of inflammation-targeting radioligands for atherosclerosis imaging: potential for plaque phenotype identification. EJNMMI Res 2021; 11:27. [PMID: 33730311 PMCID: PMC7969682 DOI: 10.1186/s13550-021-00772-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/05/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Many radioligands have been developed for the visualization of atherosclerosis by targeting inflammation. However, interpretation of in vivo signals is often limited to plaque identification. We evaluated binding of some promising radioligands in an in vitro approach in atherosclerotic plaques with different phenotypes. METHODS Tissue sections of carotid endarterectomy tissue were characterized as early plaque, fibro-calcific plaque, or phenotypically vulnerable plaque. In vitro binding assays for the radioligands [111In]In-DOTATATE; [111In]In-DOTA-JR11; [67Ga]Ga-Pentixafor; [111In]In-DANBIRT; and [111In]In-EC0800 were conducted, the expression of the radioligand targets was assessed via immunohistochemistry. Radioligand binding and expression of radioligand targets was investigated and compared. RESULTS In sections characterized as vulnerable plaque, binding was highest for [111In]In-EC0800; followed by [111In]In-DANBIRT; [67Ga]Ga-Pentixafor; [111In]In-DOTA-JR11; and [111In]In-DOTATATE (0.064 ± 0.036; 0.052 ± 0.029; 0.011 ± 0.003; 0.0066 ± 0.0021; 0.00064 ± 0.00014 %Added activity/mm2, respectively). Binding of [111In]In-DANBIRT and [111In]In-EC0800 was highest across plaque phenotypes, binding of [111In]In-DOTA-JR11 and [67Ga]Ga-Pentixafor differed most between plaque phenotypes. Binding of [111In]In-DOTATATE was the lowest across plaque phenotypes. The areas positive for cells expressing the radioligand's target differed between plaque phenotypes for all targets, with lowest percentage area of expression in early plaque sections and highest in phenotypically vulnerable plaque sections. CONCLUSIONS Radioligands targeting inflammatory cell markers showed different levels of binding in atherosclerotic plaques and among plaque phenotypes. Different radioligands might be used for plaque detection and discerning early from vulnerable plaque. [111In]In-EC0800 and [111In]In-DANBIRT appear most suitable for plaque detection, while [67Ga]Ga-Pentixafor and [111In]In-DOTA-JR11 might be best suited for differentiation between plaque phenotypes.
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Affiliation(s)
- Eric J Meester
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Erik de Blois
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jeff P Norenberg
- Radiopharmaceutical Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Kim van Gaalen
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Monique R Bernsen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marion de Jong
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Kim van der Heiden
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Vos A, de Jong PA, Verdoorn D, Mali WPTM, Bleys RLAW, Vink A. Histopathological characterization of intimal lesions and arterial wall calcification in the arteries of the leg of elderly cadavers. Clin Anat 2020; 34:835-841. [PMID: 33174629 PMCID: PMC8451780 DOI: 10.1002/ca.23701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/06/2022]
Abstract
Introduction Although arteries of the leg have been studied in extensively diseased amputation specimens, little is known about the composition of vascular lesions present in the general population. The aim of this study was to describe the natural development of adaptive intimal thickening, atherosclerotic lesion development and vascular calcification in the leg of a general elderly population. Materials and Methods Two hundred and seventy postmortem samples from the popliteal and posterior tibial arteries of 14 elderly cadavers were studied histologically. Results Atherosclerotic lesions were more frequently observed in the popliteal (60%) than in the posterior tibial artery (34%; p < .0005). These atherosclerotic plaques were most often nonatheromatous (80% and 83% for popliteal and posterior tibial plaques, respectively). The atheroma's that were present were small (most <25% of plaque area). Atherosclerotic plaque calcification was observed more often in the popliteal (39%) than in the posterior tibial samples (17%; p < .0005). Medial arterial calcification was observed more often in the posterior tibial (62%) than in the popliteal samples (46%; p = .008). Plaque calcification and medial arterial calcification were not associated with lumen stenosis. Conclusions In the leg of elderly cadavers, the presence of atherosclerotic plaque and intimal calcification decreases from the proximal popliteal artery to the more distal posterior tibial artery and most atherosclerotic lesions are of the fibrous nonatheromatous type. In contrast, the presence and severity of medial calcification increases from proximal to distal.
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Affiliation(s)
- Annelotte Vos
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Daphne Verdoorn
- Department of Anatomy, University Medical Center, Utrecht, The Netherlands
| | - Willem P T M Mali
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center, Utrecht, The Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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Gijsen FJH, Vis B, Barrett HE, Zadpoor AA, Verhagen HJ, Bos D, van der Steen AFW, Akyildiz AC. Morphometric and Mechanical Analyses of Calcifications and Fibrous Plaque Tissue in Carotid Arteries for Plaque Rupture Risk Assessment. IEEE Trans Biomed Eng 2020; 68:1429-1438. [PMID: 33186100 DOI: 10.1109/tbme.2020.3038038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atherosclerotic plaque rupture in carotid arteries is a major source of cerebrovascular events. Calcifications are highly prevalent in carotid plaques, but their role in plaque rupture remains poorly understood. This work studied the morphometric features of calcifications in carotid plaques and their effect on the stress distribution in the fibrous plaque tissue at the calcification interface, as a potential source of plaque rupture and clinical events. METHODS A comprehensive morphometric analysis of 65 histology cross-sections from 16 carotid plaques was performed to identify the morphology (size and shape) and location of plaque calcifications, and the fibrous tissue fiber organization around them. Calcification-specific finite element models were constructed to examine the fibrous plaque tissue stresses at the calcification interface. Statistical correlation analysis was performed to elucidate the impact of calcification morphology and fibrous tissue organization on interface stresses. RESULTS Hundred-seventy-one calcifications were identified on the histology cross-sections, which showed great variation in morphology. Four distinct patterns of fiber organization in the plaque tissue were observed around the calcification. They were termed as attached, pushed-aside, encircling and random patterns. The stress analyses showed that calcifications are correlated with high interface stresses, which might be comparable to or even above the plaque strength. The stress levels depended on the calcification morphology and fiber organization. Thicker calcification with a circumferential slender shape, located close to the lumen were correlated most prominently to high interface stresses. CONCLUSION Depending on its morphology and the fiber organization around it, a calcification in an atherosclerotic plaque can act as a stress riser and cause high interface stresses. SIGNIFICANCE This study demonstrated the potential of calcifications in atherosclerotic plaques to cause elevated stresses in plaque tissue and provided a biomechanical explanation for the histopathological findings of calcification-associated plaque rupture.
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10
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Baykara S, Gündoğan Bozdağ P, Baykara M, Namlı MN. Evaluation of arterial stiffness in patients with schizophrenia. J Clin Neurosci 2020; 79:149-153. [PMID: 33070886 DOI: 10.1016/j.jocn.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate arterial stiffness in schizophrenia patients. 28 male patients were included. The intima-media thickness (IMT) of the vessels were taken using high-resolution ultrasonography system. The mean carotid IMT and the mean femoral IMT values of the study group were found to be statistically significantly higher than the values of the control group. As the duration of the disease increased, there was an increase in the carotid IMT, carotid elastic modulus and femoral IMT, whereas there was a decrease in carotid and femoral diastolic wall stress in patients. No statistically significant differences were observed between the groups' carotid and femoral compliance, distensibility and elastic modulus values. The mean systolic arterial blood pressure in the patient group was determined to be lower than that of the control group. The mean diastolic wall stress values in the carotid and femoral arteries were determined to be lower than those of the control group. There was no relationship between antipsychotic dose, blood pressure and arterial stiffness parameters. Schizophrenia patients are more prone to develop arterial stiffness by atherosclerosis either with the effect of the nature of the disease itself or antipsychotic treatment. But evaluation with more parameters (carotid and femoral compliance, distensibility and elastic modulus) did not indicate any difference from the control group in respect of arterial stiffness. Antipsychotic treatment may play a protective role in terms of arterial stiffness by causing a decrease in systolic arterial pressure and carotid and femoral diastolic wall stress.
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Affiliation(s)
- Sema Baykara
- Fırat University, Faculty of Medicine, Department of Psychiatry, Elazig, Turkey.
| | | | - Murat Baykara
- Fırat University, Faculty of Medicine, Department of Radiology, Elazig, Turkey
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Burkert J, Kochová P, Tonar Z, Cimrman R, Blassová T, Jashari R, Fiala R, Špatenka J. The time has come to extend the expiration limit of cryopreserved allograft heart valves. Cell Tissue Bank 2020; 22:161-184. [PMID: 32583302 DOI: 10.1007/s10561-020-09843-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022]
Abstract
Despite the wide choice of commercial heart valve prostheses, cryopreserved semilunar allograft heart valves (C-AHV) are required, and successfully transplanted in selected groups of patients. The expiration limit (EL) criteria have not been defined yet. Most Tissue Establishments (TE) use the EL of 5 years. From physiological, functional, and surgical point of view, the morphology and mechanical properties of aortic and pulmonary roots represent basic features limiting the EL of C-AHV. The aim of this work was to review methods of AHV tissue structural analysis and mechanical testing from the perspective of suitability for EL validation studies. Microscopic structure analysis of great arterial wall and semilunar leaflets tissue should clearly demonstrate cells as well as the extracellular matrix components by highly reproducible and specific histological staining procedures. Quantitative morphometry using stereological grids has proved to be effective, as the exact statistics was feasible. From mechanical testing methods, tensile test was the most suitable. Young's moduli of elasticity, ultimate stress and strain were shown to represent most important AHV tissue mechanical characteristics, suitable for exact statistical analysis. C-AHV are prepared by many different protocols, so as each TE has to work out own EL for C-AHV.
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Affiliation(s)
- Jan Burkert
- Department of Transplantation and Tissue Banking, Czech National Allograft Heart Valve Bank, Department of Cardiovascular Surgery, Motol University Hospital, and Second Faculty of Medicine Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Petra Kochová
- Department of Transplantation and Tissue Banking, Czech National Allograft Heart Valve Bank, Department of Cardiovascular Surgery, Motol University Hospital, and Second Faculty of Medicine Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic. .,NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Technická 8, Pilsen, Czech Republic.
| | - Zbyněk Tonar
- NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Technická 8, Pilsen, Czech Republic.,Department of Histology and Embryology, Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Karlovarská 48, 301 66, Pilsen, Czech Republic
| | - Robert Cimrman
- NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Technická 8, Pilsen, Czech Republic
| | - Tereza Blassová
- Department of Histology and Embryology, Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Karlovarská 48, 301 66, Pilsen, Czech Republic
| | - Ramadan Jashari
- European Homograft Bank, Saint-Jean Clinic, Rue du Meridien 100, 1210, Brussels, Belgium
| | - Radovan Fiala
- Department of Transplantation and Tissue Banking, Czech National Allograft Heart Valve Bank, Department of Cardiovascular Surgery, Motol University Hospital, and Second Faculty of Medicine Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jaroslav Špatenka
- Department of Transplantation and Tissue Banking, Czech National Allograft Heart Valve Bank, Department of Cardiovascular Surgery, Motol University Hospital, and Second Faculty of Medicine Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic
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12
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Lindeman JH, Hulsbos L, van den Bogaerdt AJ, Geerts M, van Gool AJ, Hamming JF, van Dijk RA, Schaapherder AF. Qualitative evaluation of coronary atherosclerosis in a large cohort of young and middle-aged Dutch tissue donors implies that coronary thrombo-embolic manifestations are stochastic. PLoS One 2018; 13:e0207943. [PMID: 30481212 PMCID: PMC6258539 DOI: 10.1371/journal.pone.0207943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/08/2018] [Indexed: 01/14/2023] Open
Abstract
Background and aims With the intention to gain support for the hypothesis that incident ischemic complications of atherosclerotic disease involve a stochastic aspect, we performed a histological, qualitative evaluation of the epidemiology of coronary atherosclerotic disease in a cohort of aortic valve donors. Patients and methods Donors (n = 695, median age 54, range 11–65 years) were dichotomized into a non-cardiovascular (non-CVD) and a cardiovascular disease death (CVD) group. Consecutive 5 mm proximal left coronary artery segments were Movat stained, and the atherosclerotic burden for each segment was graded (revised AHA-classification). Results Non-CVD and CVD groups showed steep increase of atherosclerosis severity beyond the age of 40, resulting in an endemic presence of advanced atherosclerosis in men over 40 and women over 50 years. In fact, only 19% of the non-CVD and 6% of the CVD donors over 40 years were classified with a normal LCA or a so called non-progressive lesion type. Fibrous calcified plaques (FCP), the consolidated remnants of earlier ruptured lesions, dominated in both non-CVD and CVD donors. Estimates of the atherosclerosis burden (i.e. average lesion grade, proportion of FCPs, and average number of FCPs per cross-section) were all higher in the CVD group (p<1.10−16, p<0.0001, and p<0.05, respectively). Conclusions Dominance of consolidated FCP lesions in males over 40 and females over 50 years, show that plaque ruptures in the left coronary artery are common. However, the majority of these ruptures remain asymptomatic. This implies that the atherosclerotic process is repetitive. A relative difference in disease burden between CVD and non-CVD donors supports the concept that complications of atherosclerotic disease involve a stochastic element.
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Affiliation(s)
- Jan H. Lindeman
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Luuk Hulsbos
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marlieke Geerts
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jaap F. Hamming
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Rogier A. van Dijk
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Mizutani K, Torimoto I, Sekikawa Z, Nishii T, Kawasaki T, Kasama K, Goto T, Takebayashi S. Semiautomatic Volumetry of Low Attenuation of Thoracic Aortic Plaques on Curved Planar Reformations Using MDCT Angiographic Data with 0.5 mm Collimation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3563817. [PMID: 29951535 PMCID: PMC5987240 DOI: 10.1155/2018/3563817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/15/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
Abstract
To evaluate the relationship of aortic low attenuation plaque volume (LAPV) on multidetector computed tomography (MDCT) with the abdominal aortic aneurysm (AAA), the coronary arterial disease (CAD, ≥50% stenosis), severe (≥90% stenosis) CAD, hypertension, and long-term (≥10 years) hypertension. Curved planar reformations (CPR) of three segments (the ascending, the arch, and the upper descending aorta) of the thoracic aorta were generated with attenuation-dependent color codes to measure LAPV with 0~29 HU and total noncalcified plaque volume (TNPV) with 0~150 HU in 95 patients. Correlation coefficients were employed to assess the impact of each LAPV and TNPV on AAA, CAD, severe CAD, hypertension, and long-term hypertension. Each Mean LAPV/cm and TNPV/cm was statistically greater in the aortic arch than the ascending (p < 0.001 on each) or the proximal descending segment (p < 0.001 on each). LAPV in the aortic arch has moderate correlations with AAA, severe CAD, and long-term hypertension (r = 0.643, 0.639, 0.662, resp.). Plaque volumes in each aortic segment can be measured clinically and the increasing LAPV in the arch may be a significant factor associated with the development of severe atherosclerosis underlying AAA, severe CAD, and long-term hypertension.
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Affiliation(s)
- Kenji Mizutani
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Izumi Torimoto
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Zenjiro Sekikawa
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Nishii
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawasaki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiichiro Kasama
- Department of Cardiovascular Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigeo Takebayashi
- Department of Diagnostic Radiology, Yokohama City University Medical Center, Yokohama, Japan
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Mendizábal B, Urbina EM. Subclinical Atherosclerosis in Youth: Relation to Obesity, Insulin Resistance, and Polycystic Ovary Syndrome. J Pediatr 2017; 190:14-20. [PMID: 28712518 DOI: 10.1016/j.jpeds.2017.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Brenda Mendizábal
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH.
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15
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Coronary calcium scores: From histology to preventive cardiology. Int J Cardiol 2017; 229:34. [DOI: 10.1016/j.ijcard.2016.11.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/21/2016] [Indexed: 11/21/2022]
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