Plaque Fissure and Calcified Nodule: Histopathological Findings

CVPath recently published a review article in the European Heart Journal. The review provides insight into the specific plaque phenotypes that contribute to coronary artery disease (CAD) and clarifies the distinctions between plaque fissure and rupture, as well as between calcified nodules and nodular calcification. Plaque fissures are characterized by a lateral tear in an eccentric lesion that extends across a thick fibrous cap and ends in a small necrotic core, whereas in ruptures, a thin fibrous cap is disrupted and associated with significant infiltration of macrophages and T-lymphocytes. Calcified nodules are fragments of dense calcium interspersed by fibrin that protrude into the vessel lumen and trigger a luminal thrombus, which is usually non-occlusive. These nodules typically appear as eccentric lesions with a convex luminal surface devoid of fibrous tissue or endothelium. While nodular calcifications are similar, the overlying thick fibrous cap is intact, lined by endothelial cells, and devoid of thrombus. Additionally, in this review article, the authors examine the shifting presentations of acute coronary syndrome (ACS) and evolving morphologies of culprit lesions, while exploring how advanced coronary imaging technologies are revolutionizing their detection and treatment. The paper was led by Dr. Teruo Sekimoto, who completed his CVPath research fellowship in March 2025, and by CVPath research scientist Dr. Alyssa Grogan. Click here to read the full article.