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Atherosclerotic Plaque Hemorrhage and Rupture Associated with Crescendo Claudication

Michael Mecley, MD; Kenneth Rosenfield, MD; Jenifer Kaufman, BS; R. Eugene Langevin Jr., MD; Syed Razvi, MD; and Jeffrey M. Isner, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by grants from the National Heart, Lung, and Blood Institute (HL40518, 1 K07 HL02824-01), National Institutes of Health; and the Cora and John Davis Foundation.

Requests for Reprints: Jeffrey M. Isner, MD, St. Elizabeth's Hospital, 736 Cambridge Street, Boston, MA 02135.

Current Author Addresses: Drs. Mecley, Rosenfield, and Isner, and Ms. Kaufman: Department of Medicine, St. Elizabeth's Hospital, 736 Cambridge Street, Boston, MA 02135.

Dr. Langevin: Department of Radiology, St. Elizabeth's Hospital, 736 Cambridge Street, Boston, MA 02135.

Dr. Razvi: Department of Vascular Surgery, St. Elizabeth's Hospital, 736 Cambridge Street, Boston, MA 02135.

Ann Intern Med. 1992;117(8):663-666. doi:10.7326/0003-4819-117-8-663
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This excerpt has been provided in the absence of an abstract.

Unstable atherosclerotic plaque morphology has been established as the major factor responsible for escalating symptoms of myocardial ischemia and extracranial vascular disease. Previous histopathologic (1-5) and ultrasound (6) studies have suggested that plaque hemorrhage, plaque rupture, and intraluminal thrombosis characterize the sequence of pathologic findings in such cases. Surprisingly, however, this same sequence of unstable plaque morphology has not been previously recognized as a basis for accelerated symptoms of arterial insufficiency in patients with peripheral vascular disease. The evidence we obtained by directional atherectomy and intravascular ultrasound suggests that unstable plaque morphology should be considered as a pathogenetic mechanism for


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