Immune cells in carotid artery plaques: what can we learn from endarterectomy specimens?

Int Angiol. 2020 Feb;39(1):37-49. doi: 10.23736/S0392-9590.19.04250-0. Epub 2019 Nov 25.


Introduction: Endarterectomy specimens represent a unique opportunity to study atherosclerosis. This review aims to summarize the recent knowledge of atherogenesis from studies characterizing a cellular composition of carotid endarterectomy specimens.

Evidence acquisition: A non-systematic literature review was carried out to summarize recent knowledge regarding ex vivo analysis of carotid artery plaque composition. Upon evaluation of their relevance, and elaborate forward and backward search, 95 articles were included in the review.

Evidence synthesis: Despite the significant advancement of in vivo imaging techniques, the stroke prediction based on carotid artery plaque morphology is not reliable. Besides analyses of plaque morphology, present studies focus on precise characterization of the different immune cell types and elucidation of their role in plaque development. Plaque content analyses revealed the presence of various immune cells in carotid artery plaques. Presence of different immune cells subpopulations can be connected to some undesirable changes in plaque stability.

Conclusions: Since the destabilization of the atherosclerotic plaque is a multifactorial process, a combination of various methods should be used to characterize the unstable plaques more accurately. In this context, studies characterizing plaque content from a cellular point of view could elucidate some processes underlying the plaque progression. Together with morphological evaluation, these analyses could enable more precise assessment of plaque stability.

Publication types

  • Review

MeSH terms

  • Antigens, CD / analysis
  • Atherosclerosis / immunology*
  • Atherosclerosis / pathology
  • Atherosclerosis / surgery
  • Carotid Stenosis / immunology*
  • Carotid Stenosis / pathology
  • Carotid Stenosis / surgery
  • Endarterectomy, Carotid
  • Flow Cytometry
  • Humans
  • Immunohistochemistry
  • Macrophages / immunology*
  • Plaque, Atherosclerotic / pathology*
  • T-Lymphocytes / immunology


  • Antigens, CD