Hiyama Takami, Tanaka Toshihide, Endo Shinichi, Komine Kazumasa, Kudo Tadashi, Kobayashi Hiroo, Shiokawa Yoshiaki
Department of Neurosurgery, Ishioka Cardiology and Neurosurgery Hospital, Omitama, Ibaraki.
Neurol Med Chir (Tokyo). 2010;50(12):1056-61. doi: 10.2176/nmc.50.1056.
Carotid plaque with hemorrhage leads to cerebral embolism and ischemic stroke. Plaque angiogenesis and angiogenetic factors such as vascular endothelial growth factor (VEGF) are critical in the progression of atherosclerotic carotid plaque and intraplaque hemorrhage. The correlation between plaque angiogenesis and presence of clinical symptoms was studied in 41 specimens obtained during carotid endarterectomy from 20 symptomatic and 21 asymptomatic patients treated for carotid artery stenosis. Histological findings using hematoxylin-eosin and immunohistochemical staining against von Willebrand factor and VEGF were examined. Intraplaque hemorrhage, calcification, necrosis, and invasion of foam cells were frequently observed in the carotid plaques from symptomatic patients compared with asymptomatic patients. Higher microvessel density was found in the carotid plaques with necrosis and invasion of foam cells compared with plaques without necrosis and/or foam cell invasion, and higher expression of VEGF was found from symptomatic patients compared with asymptomatic patents. These results suggest that plaque angiogenesis and higher level of VEGF expression may enhance the progression of ischemic symptoms in patients with carotid artery stenosis. Invasive macrophages in the plaque of symptomatic patients increase levels of VEGF and might enhance plaque angiogenesis and atherosclerosis progression.
伴有出血的颈动脉斑块会导致脑栓塞和缺血性中风。斑块血管生成以及血管内皮生长因子（VEGF）等血管生成因子在动脉粥样硬化性颈动脉斑块和斑块内出血的进展中起着关键作用。对20例有症状和21例无症状的颈动脉狭窄患者在颈动脉内膜切除术期间获取的41个标本，研究了斑块血管生成与临床症状存在之间的相关性。检查了苏木精-伊红染色以及针对血管性血友病因子和VEGF的免疫组织化学染色的组织学结果。与无症状患者相比，有症状患者的颈动脉斑块中经常观察到斑块内出血、钙化、坏死和泡沫细胞浸润。与无坏死和/或无泡沫细胞浸润的斑块相比，有坏死和泡沫细胞浸润的颈动脉斑块中微血管密度更高，与无症状患者相比，有症状患者的VEGF表达更高。这些结果表明，斑块血管生成和更高水平的VEGF表达可能会加重颈动脉狭窄患者缺血症状的进展。有症状患者斑块中的浸润性巨噬细胞会增加VEGF水平，并可能增强斑块血管生成和动脉粥样硬化进展。
