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(Circulation. 2000;102:771.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Specific Cellular Features of Atheroma Associated With Development of Neointima After Carotid Endarterectomy

The Carotid Atherosclerosis and Restenosis Study

Paolo Pauletto, MD; Massimo Puato, MD; Elisabetta Faggin, PhD; Nicoletta Santipolo, MD; Valeria Pagliara, MD; Miranda Zoleo, MD; Giovanni Paolo Deriu, MD; Franco Grego, MD; Mario Plebani, MD; Saverio Sartore, PhD; Gabriele Bittolo Bon, MD; Christophe Heymes, PhD; Jeane-Lise Samuel, MD, PhD; Achille Cesare Pessina, MD, PhD

From Dipartimento di Medicina Clinica e Sperimentale (P.P., M.P., E.F., N.S., V.P., S.D.R., M.Z., A.C.P.), Chirurgia Vascolare I (G.P.D., F.G.), Laboratorio di Analisi (M.P.), Dipartimento di Scienze Biomediche (S.S.), Università degli Studi di Padova (Italy); Centro Regionale dell’Aterosclerosi (G.B.B.), Venezia, Italy; and INSERM U 127 (C.H., J.-L.S.), Hôpital Lariboisiere, Paris, France.

Correspondence to Prof Paolo Pauletto, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Padova, Via Giustiniani, 2-35128 Padova, Italy. E-mail pauletto{at}ux1.unipd.it

Background—The purpose of this study was to investigate whether some cellular and molecular features of tissue retrieved at carotid endarterectomy are associated with the extent of neointima formation at ultrasound follow-up.

Methods and Results—One hundred fifty patients were studied. Endarterectomy specimens were tested by immunocytochemistry with the use of (1) monoclonal antibodies that identify smooth muscle cells (SMCs) and fetal-type SMCs on the basis of smooth muscle and nonmuscle myosin content, (2) the anti-macrophage HAM 56, and (3) the anti-lymphocyte CD45RO. The maximum intima-media thickness (M-IMT) of the revascularized vessel was assessed by the use of B-mode ultrasonography 6 months after surgery. The M-IMT values were related positively to the number of SMCs (r=0.534, P<0.0005) and negatively to that of macrophages and lymphocytes (r=-0.428, P<0.0005, and -0.538, P=0.001, respectively). Patients were classified as class 1 (M-IMT 1.0 mm), class 2 (1.0<M-IMT1.3 mm), and class 3 (M-IMT >1.3 mm). An abundance of SMCs, mostly of fetal type, was found in the plaque of class 3 patients, whereas lesions from class 1 patients were rich in macrophages and lymphocytes. In the multivariate analysis, factors related to M-IMT were the number of SMCs and the percentage of fetal-type SMCs present in the plaque.

Conclusions—Although the classic risk factors did not play a role, an abundance of SMCs and a scarcity of macrophages characterized the primary lesion of patients in whom neointima developed after surgery. In patients in whom neointima did not develop, lesions were rich in macrophages and lymphocytes. This approach can be useful in defining patients at risk of restenosis.

Key Words: atherosclerosis • restenosis • carotid arteries • muscle, smooth • lymphocytes

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