Abstract
The composition of plaque and thrombus can be determined from their appearance. Plaque is classified into yellow and white according to color and smooth or complex according to shape. Complex plaque is subdivided to three categories: ulceration (erosion), intimal flap, and intimal cleft. Yellow plaque seems to have thin fibrous cap or superficial or diffuse lipid deposition with or without lipid core. Tiny calcium particle, macrophage foam cells, or degenerated collagen fiber may glisten yellow. White plaque is histologically composed of dense collagen fiber (fibrous) or thick fibrous or calcified cap covered with lipid and macrophage foam cell-free endothelia with lipid pool below. Yellow plaque is likely to be vulnerable, whereas white plaque seems to be stable.
Thrombus is classified into red and white according to color and mural and luminal according to shape. White thrombus is platelet rich; on one hand, red thrombus contains an abundance of fibrin mixed with erythrocytes and platelets. This pathological presentation may explain why the thrombolysis treatment using tPA is less effective in patients with unstable angina or non-ST elevation myocardial infarction.
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Mizuno, K. (2015). Classification of Plaque and Thrombus. In: Mizuno, K., Takano, M. (eds) Coronary Angioscopy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55546-9_6
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