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. 2021 Jun 8;43(4):1703–1723. doi: 10.1007/s11357-021-00392-4

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Representative cross-section of an unstable carotid plaque removed during carotid endarterectomy stained by HE. The plaque is composed of a large amount of fibrotic tissue in the plaque and the cap of the plaque. Grade 4 plaques are characterized by a rupture (Rup) in the fibrous cap of the plaque (Cap), presence of a thrombus (Thr) and intraplaque hemorrhage (Hem); inflammation (Inf); calcification (Cal); medial smooth muscle cells (M); lumen (Lum) (a). A representative magnified image of inflammatory cells plaque tissue stained by HE (b). An image with CD68 positive macrophage staining. Arrows points to positively stained cells in plaque tissue. The high number of CD68 positive macrophages and foam cells in the plaques are histological features of the unstable plaques (c) [51].