Arterioesclerosis carotídea: correlación clínico-histológica de placas vulnerables

espanolObjetivos: Caracterizar histologicamente placas humanas carotideas vulnerables para plantear nuevas opciones diagnosticas y terapeuticas mediante la aplicacion de nanomateriales en pacientes asintomaticos. Metodos: Se incluyeron tres pacientes varones, con enfermedad carotidea e indicacion quirurgica (endarterectomia). Las placas fueron tenidas con hematoxilina-eosina, tricromico de Masson, picrosirius y orceina. Se analizaron histologicamente, determinando su remodelamiento, nucleo lipidico, infiltracion inflamatoria, presencia de celulas espumosas, calcificacion y neovascularizacion con hemorragia. Se realizo un analisis estadistico comparativo del porcentaje de fibrosis, asi como de su intensidad por tercios entre las muestras e intramuestra. Resultados: A nivel clinico, la placa 1 era sintomatica, correspondia a un paciente con antecedente de accidente isquemico transitorio, el paciente 2 presentaba un aneurisma carotideo con gran trombo mural y la placa 3 era asintomatica. A nivel histologico, las placas 1 y 2 se asociaban con un estadio mas evolucionado que la placa 3. Las placas 1 y 2 presentaron ruptura de su pared, intenso infiltrado de macrofagos, abundante calcificacion y neovascularizacion con hemorragia intraplaca. Las placas carotideas diferian principalmente en el grado de fibrosis. En concreto, la placa 3 destaco por la presencia de celulas espumosas migrando hacia el nucleo lipidico y la formacion de lineas de calcificacion. El estudio estadistico mostro una notable fibrosis de la placa 1 (5,4%), siendo inferior en la placa 3 (2,51%) y en la 2 (1,84%). Asi mismo, se observaron diferencias estadisticamente significativas al comparar el tercio inferior de las placas 1 y 3, y en el analisis intramuestra de la placa 2. Conclusiones: El presente estudio permitio determinar las caracteristicas histologicas de placas vulnerables que se pueden asociar con la manifestacion de sintomas clinicos. Estos hallazgos, sugieren un conocimiento potencial para el desarrollo de nuevas opciones diagnosticas y terapeuticas que mejoren las herramientas actualmente disponibles. EnglishObjectives: Histological characterization of vulnerable human carotid plaques to propose new diagnostic and therapeutic options through the application of tissue engineering strategies in asymptomatic patients. Methods: In this study three male patients were included who presented carotid disease with surgical criteria (classic endarterectomy). The plaques were stained with hematoxylin-eosin, Masson’s trichrome, picrosirius and orcein. All samples were histologically analyzed to study remodeling capability, lipid nucleus, inflammatory infiltration, presence of foam cells, calcification, neovascularization and intraplaque hemorrhage. In addition, we performed a comparative statistical analysis of the fibrosis percentage, as well as its intensity by thirds between samples and intra-sample. Results: Clinical analysis revealed that Plaque 1 was syntomathic, trigging a stroke. Plaque 2 set up a carotid aneurism with a large mural thrombus. Plaque 3 was asynthomatic. Histologycal analysis from Plaques 1 and 2 determined they had developed a more advanced stage than Plaque 3. Plaques 1 and 2 were rupture plaques with a severe macrophages infiltrated and overall calcification and neovascularization with hemorrage. All plaques differed in the degree of fibrosis. At Plaque 3 foams cells were standing out, migrating to lipidic nucleous, as well as calcification lines. Statistic analysis presented a notorious Plaque 1 fibrosis (5,4%), below Plaque 3 (2,51%), and Plaque 2 (1,84%). They were statistically significant differences between the lower third of Plaques 1 and, 3, and at intra-sample analysis of Plaque 2. Conclusions: The present study allowed us to determine the histological characteristics of vulnerable plaques that can be associated with the manifestation of clinical symptoms. These findings suggest a potential knowledge for the development of new diagnostic and therapeutic options that improve clinical currently available tools.