Interview, News, Publication

Understanding the pathology of plaque progression and regression

September 29th, 2023

Caption: A chart depicting characteristics of plaque morphology across different stages of progression.

CVPath Institute is excited to announce that a recent article by Arielle Bellissard, Renu Virmani, and Aloke Finn has been published by Elsevier in the journal Trends in Cardiovascular Medicine


In the article, Bellissard et al. discuss the critical significance of correctly identifying different plaque progression and regression mechanisms before the occurrence of acute coronary syndromes such as acute myocardial infarction and unstable angina. In plaque progression, the lumen of the artery can become narrowed due to the build-up of a lesion comprised of cells such as smooth muscle cells (SMCs), lipids, white blood cells, and collagen underneath the innermost layer of the artery called the intima. Bellissard et al. outline the detailed processes in which stable plaques like fibroatheromas (FA), healed plaque rupture (HPR), fibrocalcific plaques, and chronic total occlusion (CTO) may form over decades, eventually narrowing and hardening the artery. Meanwhile, unstable plaques will progress rapidly and rupture the intima, thereby clotting the artery (thrombosis) and causing severe complications to the heart. As the article notes, the build-up of stable plaque is the leading cause of coronary artery disease and sudden heart failure. While thrombosis is most likely to occur from plaque rupture, it can also happen in plaque erosion when a thrombus is in direct contact with blood flow through a weak and deteriorated endothelial cell barrier of the intima.


Bellissard et al. also note that improving non-invasive tools to identify high-risk lesions would significantly expand preventative care and further develop what we currently know about plaque progression and regression.


While reflecting on her newest publication, Bellissard said in an interview, “We wrote this article to add pathological insight to Drs. Aldana-Biter, Bhatt, and Budoff’s review on how to diagnose, treat, and prevent plaque progression in the coronaries.¹ Imaging techniques have made a lot of progress recently but are still not completely accurate for the classification of atherosclerotic plaques, hence why pathology remains so important. We wanted to help the reader better understand the mechanisms underlying plaque formation and leading to the symptoms and images they analyze during their clinical practice.”


If you would like to read Bellissard et al.’s article “Understanding the pathology of plaque progression and regression”, please access the link below:


¹Aldana-Bitar, Jairo, Deepak L. Bhatt, and Matthew J. Budoff. “Regression and stabilization of atherogenic plaques.” Trends in Cardiovascular Medicine (2023).


Written by Gina Miller