Summary
There are multiple substrates for coronary thrombosis overlying an atherosclerotic
plaque. The most common, plaque rupture, consists of an interruption of a thin fibrous
cap overlying a lipid rich core. Plaque rupture is a result of macrophage infiltration
and matrix degradation, is often seen in calcified plaques, and is highly associated
with hypercholesterolemia. A less common substrate, plaque erosion, is not associated
with elevated cholesterol and is the prime cause of coronary thrombosis in premenopausal
women. The characteristic histologic features are abundant surface smooth muscle cells
and proteoglycans, and a small or absent lipid rich core. The mechanisms of plaque
erosion are unclear, and there are no consistent risk factors, although patients are
often smokers.
Key words
Coronary atherosclerosis - coronary thrombosis - plaque rupture - risk factors
