Which is the role of histology in the diagnosis of coronary artery atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
  • Print
Answer

A system devised by Stary et al classifies atherosclerotic lesions according to their histologic composition and structure. [7]

In a type I lesion, the endothelium expresses surface adhesion molecules E selectin and P selectin, attracting more polymorphonuclear cells and monocytes in the subendothelial space.

In a type II lesion, macrophages begin to take up large amounts of LDL (fatty streak).

In a type III lesion, as the process continues, macrophages become foam cells.

In a type IV lesion, lipid exudes into the extracellular space and begins to coalesce to form the lipid core.

In a type V lesion, SMCs and fibroblasts move in, forming fibroatheromas with soft inner lipid cores and outer fibrous caps.

In a type VI lesion, rupture of the fibrous cap with resultant thrombosis causes ACS.

As lesions stabilize, they become fibrocalcific (type VII lesion) and, ultimately, fibrotic with extensive collagen content (type VIII lesion).


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!