ArticleProceedings of the National Academy of Sciences of the United States of America2013
Revised microcalcification hypothesis for fibrous cap rupture in human coronary arteries.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 185 papers.
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Who cites it
185 citing papers in PubMed.
- Effects of Evolocumab on Coronary Plaque Composition and Microcalcification Activity by Coronary PET and CT Angiography.JACC. Cardiovascular imaging · 2025Trial
- Thoracic aorta calcification but not inflammation is associated with increased cardiovascular disease risk: results of the CAMONA study.European journal of nuclear medicine and molecular imaging · 2017Trial
- Diagnostic value of a combined model for acute aortic syndrome based on internal migration of calcification on non-contrast computed tomography.Journal of thoracic disease · 2026Article
- Review
- From anatomy to vulnerability: A comprehensive appraisal of coronary physiology and plaque characterization.American heart journal plus : cardiology research and practice · 2026Review
- The changing epidemiology of human type 2 diabetes-associated atherosclerosis: Pathophysiological mechanisms and emerging treatment possibilities.Journal of internal medicine · 2026Review
- Territorial heterogeneity of atherosclerosis and vascular calcification.Nature cardiovascular research · 2026Review
- Microcalcification: Effects on Atherosclerotic Vulnerable Plaques, Detection, and Therapeutic Perspectives.Current atherosclerosis reports · 2026Review
- Role and mechanisms of vascular smooth muscle cell phenotypic transition in diabetic macrovascular complications.Biological research · 2026Review
- Biomechanics of Plaque Rupture and Cardiovascular Calcification.Advances in experimental medicine and biology · 2026Review
- Mechanosensor Piezo1‑mediated smooth muscular cell pyroptosis contributes to vascular calcification.International journal of molecular medicine · 2025Article
- AI-based modality-agnostic classification system for vascular calcifications.Scientific reports · 2025Article
- Atherosclerotic Plaque Instability and Rupture: Recommended Mouse Models to Empower Clinically Relevant Discoveries, Diagnostics, and Therapeutics.Arteriosclerosis, thrombosis, and vascular biology · 2025Review
- Modelling Atherosclerotic Plaque Cap Mechanics: Microcalcifications Reduce Mechanical Properties in Mesenchymal Stromal Cell-Based Model.Advanced biology · 2025Article
- Smooth muscle cell-specific deletion of TXNIP ameliorates medial vascular calcification.Experimental & molecular medicine · 2025Article
- Associations of subclinical microcalcification and inflammation with carotid atheroma development: a dual-tracer PET/CT study.European journal of nuclear medicine and molecular imaging · 2025Observational
- Considerations on the Development of Therapeutics in Vascular Calcification.Journal of cardiovascular development and disease · 2025Review
- Exosomal non-coding RNAs: key regulators of inflammation-related cardiovascular disorders.European journal of medical research · 2025Review
- Clinical Outcomes of Rotational Atherectomy in the Drug-Eluting Stent Era.Journal of clinical medicine · 2025Review
- Hepatic Steatosis Aggravates Vascular Calcification via Extracellular Vesicle-Mediated Osteochondrogenic Switch of Vascular Smooth Muscle Cells.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2025Article
125 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
Abstract
Using 2.1-µm high-resolution microcomputed tomography, we have examined the spatial distribution, clustering, and shape of nearly 35,000 microcalcifications (µCalcs) ≥ 5 µm in the fibrous caps of 22 nonruptured human atherosclerotic plaques. The vast majority of these µCalcs were <15 µm and invisible at the previously used 6.7-µm resolution. A greatly simplified 3D finite element analysis has made it possible to quickly analyze which of these thousands of minute inclusions are potentially dangerous. We show that the enhancement of the local tissue stress caused by particle clustering increases rapidly for gap between particle pairs (h)/particle diameter (D) < 0.4 if particles are oriented along the tensile axis of the cap. Of the thousands of µCalcs observed, there were 193 particle pairs with h/D ≤ 2 (tissue stress factor > 2), but only 3 of these pairs had h/D ≤ 0.4, where the local tissue stress could increase a factor > 5. Using nondecalcified histology, we also show that nearly all caps have µCalcs between 0.5 and 5 µm and that the µCalcs ≥ 5 µm observed in high-resolution microcomputed tomography are agglomerations of smaller calcified matrix vesicles. µCalcs < 5 µm are predicted to be not harmful, because the tiny voids associated with these very small particles will not explosively grow under tensile forces because of their large surface energy. These observations strongly support the hypothesis that nearly all fibrous caps have µCalcs, but only a small subset has the potential for rupture.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.