Segmental Heterogeneity of Vasa Vasorum Neovascularization in Human Coronary Atherosclerosis

Mario Gössl, Daniele Versari, Heike A. Hildebrandt, Thomas Bajanowski, Giuseppe Sangiorgi, Raimund Erbel, Erik L. Ritman, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Objectives: Our aim was to investigate the role of coronary vasa vasorum (VV) neovascularization in the progression and complications of human coronary atherosclerotic plaques. Background: Accumulating evidence supports an important role of VV neovascularization in atherogenesis and lesion location determination in coronary artery disease. VV neovascularization can lead to intraplaque hemorrhage, which has been identified as a promoter of plaque progression and complications like plaque rupture. We hypothesized that distinctive patterns of VV neovascularization and associated plaque complications can be found in different stages of human coronary atherosclerosis. Methods: Hearts from 15 patients (age 52 ± 5 years, mean ± SEM) were obtained at autopsy, perfused with Microfil (Flow Tech, Inc., Carver, Massachusetts), and subsequently scanned with micro-computed tomography (CT). The 2-cm segments (n = 50) were histologically classified as either normal (n = 12), nonstenotic plaque (<50% stenosis, n = 18), calcified (n = 10) or noncalcified (n = 10) stenotic plaque. Micro-CT images were analyzed for VV density (number/mm2), VV vascular area fraction (mm2/mm2), and VV endothelial surface fraction (mm2/mm3). Histological sections were stained for Mallory's (iron), von Kossa (calcium), and glycophorin-A (erythrocyte fragments) as well as endothelial nitric oxide synthase, vascular endothelial growth factor, and tumor necrosis factor-alpha. Results: VV density was higher in segments with nonstenotic and noncalcified stenotic plaques as compared with normal segments (3.36 ± 0.45, 3.72 ± 1.03 vs. 1.16 ± 0.21, p < 0.01). In calcified stenotic plaques, VV spatial density was lowest (0.95 ± 0.21, p < 0.05 vs. nonstenotic and noncalcified stenotic plaque). The amount of iron and glycophorin A was significantly higher in nonstenotic and stenotic plaques as compared with normal segments, and correlated with VV density (Kendall-Tau correlation coefficient 0.65 and 0.58, respectively, p < 0.01). Moreover, relatively high amounts of iron and glycophorin A were found in calcified plaques. Further immunohistochemical characterization of VV revealed positive staining for endothelial nitric oxide synthase and tumor necrosis factor-alpha but not vascular endothelial growth factor. Conclusions: Our results support a possible role of VV neovascularization, VV rupture, and intraplaque hemorrhage in the progression and complications of human coronary atherosclerosis.

Original languageEnglish (US)
Pages (from-to)32-40
Number of pages9
JournalJACC: Cardiovascular Imaging
Issue number1
StatePublished - Jan 2010


  • calcification
  • human coronary atherosclerosis
  • intraplaque hemorrhage
  • micro-CT
  • vasa vasorum

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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