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Background <p>The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (US) populations as do the plaque features on imaging.</p> Objectives <p>The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and US patients.</p> Methods <p>Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10-µm thickness) at 0.5–1&#xa0;mm intervals. Hematoxylin and eosin staining and Mallory’s trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups.</p> Results <p>A total of 1152 histological sections from 75 Chinese patients and 1843 sections from 111 US patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3&#xa0;mm, <i>p</i> = 0.046) and a larger percent wall volume (median: 74% vs. 70%, <i>p</i> = 0.018) than the US group. After adjusting for confounding factors, carotid plaques in the Chinese population had larger lipid pools (<i>β</i> = 10.0%, 95% <i>CI</i>: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; <i>β</i> = 8.4%, 95% <i>CI</i>: 4.5 to 12.7%), less late IPH (<i>β</i> = − 8.2%, 95% <i>CI</i>: − 11.3 to − 5.4), and fewer fibrous cap disruptions (45% vs. 67%, <i>p</i> = 0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did US plaques (20% vs 2.7%, <i>p</i> &lt; 0.001).</p> Conclusions <p>The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which indicates a need for a different management approach.</p> Graphical Abstract <p></p>

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Composition of carotid plaques differs between Chinese and US patients: a histology study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月9日

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  • Jingli Cao,
  • Marina Ferguson,
  • Jie Sun,
  • Mi Shen,
  • Randy Small,
  • Daniel S. Hippe,
  • Xihai Zhao,
  • Dong Zhang,
  • Hiroko Watase,
  • Chun Yuan,
  • Peiyi Gao,
  • James Kevin DeMarco,
  • Roberto F. Nicosia,
  • Yajie Wang,
  • Haowen Li,
  • Zirui Li,
  • Yi Wang,
  • Ted Kohler,
  • Thomas Hatsukami,
  • Binbin Sui

摘要

Background

The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (US) populations as do the plaque features on imaging.

Objectives

The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and US patients.

Methods

Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10-µm thickness) at 0.5–1 mm intervals. Hematoxylin and eosin staining and Mallory’s trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups.

Results

A total of 1152 histological sections from 75 Chinese patients and 1843 sections from 111 US patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3 mm, p = 0.046) and a larger percent wall volume (median: 74% vs. 70%, p = 0.018) than the US group. After adjusting for confounding factors, carotid plaques in the Chinese population had larger lipid pools (β = 10.0%, 95% CI: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; β = 8.4%, 95% CI: 4.5 to 12.7%), less late IPH (β = − 8.2%, 95% CI: − 11.3 to − 5.4), and fewer fibrous cap disruptions (45% vs. 67%, p = 0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did US plaques (20% vs 2.7%, p < 0.001).

Conclusions

The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which indicates a need for a different management approach.

Graphical Abstract