Chinese Neurosurgical Journal Study Compares Carotid Plaque Composition in Patients from China and US

Researchers investigated and compared the histological features of excised carotid plaques from patients from China and the US

BEIJING, BEIJING, CHINA, November 11, 2025 /EINPresswire.com/ -- Carotid plaques block the blood supply to the brain. It is often considered a leading cause of stroke. Ethnicity-based characteristics and differences in the plaques are studied to tailor targeted management approaches. In a recently published study in the Chinese Neurosurgical Journal, histological features of carotid plaques from patients of Chinese and North American populations were investigated and compared, reporting distinct histological differences.

Atherosclerotic cerebrovascular disease refers to a condition where plaque builds up in the arteries that supply blood to the brain, leading to reduced flow of oxygen-rich blood. This can cause life-threatening cerebrovascular events, including a stroke. Plaque build-up in the carotid arteries, the pair of blood vessels on each side of the neck that supplies oxygen-rich blood to the brain, face, and head, is often considered a major cause of ischemic stroke. Understanding the pathophysiology of the plaques is the first step towards developing preventive measures.

Stroke is a leading cause of death and serious long-term disability among the Chinese and North American populations. However, there is a significant difference in the pattern of cerebrovascular disease in these two populations. Imaging studies done in the past have reported notable differences in the location and characteristics of stroke-causing plaques between the two populations.

Recently, a team of researchers from China, led by Professor Binbin Sui from Capital Medical University, Beijing, and Dr. Thomas Hatsukami from the University of Washington decided to analyze the histological differences in carotid advanced atherosclerotic plaques excised from patients from these two populations. “Differences in the characteristics of atherosclerotic disease and plaque composition can be linked to different preventive and treatment approaches,” mentioned Prof. Sui, while talking about the main motivation behind the study. The study was published on October 09, 2025, in Volume 11 of the Chinese Neurosurgical Journal.

Carotid endarterectomy is a surgical procedure to remove plaque buildup from the carotid arteries. Specimens from carotid endarterectomy were analyzed for the study. Samples from 75 Chinese patients and 111 US patients were collected and analyzed. Two different histological staining techniques, hematoxylin and eosin staining and Mallory’s trichrome staining, were performed; the resulting images were captured and analyzed. Different components of the plaques, including lipid pools, necrotic cores or the core of the plaque, and calcification, were compared.

The minimum lumen diameter, the inside space of the tubular carotid artery, was significantly smaller in the Chinese group compared to the US group, which translated into a more severe stenosis—narrowing of the artery. The total wall volume of the atherosclerotic plaque, or the plaque burden, was also larger in the Chinese population.

There was also a distinct difference in the morphology of the plaques between the two groups. Chinese plaques had a more homogeneous morphology than the US plaques. However, the complexity of the plaques collected from North American patients was more prominent, due to the presence of an admixture of different components. Large regions of necrosis, increased calcification, thrombosis, and haemorrhage added to the intricacy of the plaques from the US group. Intraplaque hemorrhage (IPH) is a nontraumatic bleeding that occurs within the brain's functional tissue, known as the brain parenchyma. Evidence of old and new IPH can be observed during histological investigations. The samples from Chinese patients had more recent IPH and less late IPH. Fibrous cap disruption, referring to the breakdown of the protective fibrous cap over an atherosclerotic plaque, was also less frequent in samples from Chinese patients. Lipid-filled deposits of cholesterol or xanthomas were also more prevalent in the Chinese samples, along with a uniform extracellular matrix. The Chinese plaques clearly showed fewer features of advanced atherosclerosis than the US plaques.

There is a clear discrepancy in the histology of plaques collected from Chinese and US samples. This indicates that the pathophysiology of atherosclerotic cerebrovascular disease differs significantly between the two groups. “Our findings show that variations in plaque composition can lead to fundamentally distinct lesions across populations on different continents. This can be considered while planning treatment or preventive measures for cardiovascular events,” mentioned Dr. Hatsukami.

Further comparative studies can help in understand the differences in plaque morphologies between the two populations. Comprehending these variations could facilitate improved risk evaluation and therapy customization for these two populations.

Reference
Title of original paper: Composition of carotid plaques differs between Chinese and US patients: A histology study
Journal: Chinese Neurosurgical Journal
DOI: 10.1186/s41016-025-00408-4

About Capital Medical University, Beijing

Capital Medical University (CCMU), founded in 1960, is a municipal public university in Beijing, China. It ranks among the top academic medical institutions in China, and is considered as one of the key municipal universities in Beijing. It is also listed as one of the top 300 universities in the world university rankings. CCMU provides a wide range of educational programs for Doctorates, Masters, Bachelors and certificates. CCMU is a well-known academic institution, known for its strong competence in the scientific research. It hosts many national and municipal key disciplines, laboratories and some exchange stations for post-doctoral research.

Website: https://ccmu.cucas.cn/


About Professor Binbin Sui from Capital Medical University, Beijing

Dr. Binbin Sui is a radiologist whose work focuses on neuroradiology, brain imaging, and vascular imaging. She completed her doctoral research at Capital Medical University, China, and is currently serving as a professor at the same university. She is an associate editor of Acta Radiologica. Her research is focused on structural, physiological and functional imaging of diseases related to the central nervous system. She has published over 100 papers to date.
About Dr. Thomas Hatsukami from the University of Washington
Dr. Thomas Hatsukami is a vascular surgeon with over 43 years of experience in this field. He completed medical school from the University of California, Los Angeles (UCLA) in 1982. His research group focuses on advanced high-resolution magnetic resonance imaging techniques for accurate, noninvasive examination of atherosclerosis. He is associated with the Department of Surgery at the University of Washington. He has contributed to more than 300 research articles to date.

Funding information
This study was jointly funded by the National Institutes of Health, the National Natural Science Foundation of China, and the Beijing Natural Science Foundation.

Yi Lu
Chinese Neurosurgical Journal
luyi617@sina.cn

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