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©2013 UpToDate ® Print Email Criteria for American Heart Association lesion classification system and correspondence with classification of gross arterial specimens AHA grade Criteria Comments and corresponding grossclassification 0 Normal artery with or without adaptive intimal thickening; nohold Normal tissue 1 Isolated MFCs containing lipid; no extracellular lipid;variable adaptive intimal thickening grossly with lipid staining Initial atherosclerotic lesion, sometimes visible grosslywith lipid staining 2 Numerous MFCs, often in layers, with fine particles ofextracellular licid; no distinct pools of extracellular lipid: variableadaptive intimal thickening Fatty streak, visible grossly with III staining 3 Numerous MFCs with ≥pools of extracellular lipid; no well-defined core of extracellularlipid Fatty plaque, raised fatty streak, intermediate lesion, ortransitional lesion 4 Numerous MFGs plus well-defined core of extracellular lipid,but with luminal surface covered by relatively normal intima Atheroma, fibrous plaque, or raised lesion 5 Numerous MFCs, well-defined core or multiple cores ofextracellular lipid, plus reactive fibrotic cap, vascularization, orcalcium Fibroartherema, fibrous plaque, or raised lesion 6 All of the above plus surface defect, hematoma, hemorrhage,or thrombosis Complicated lesion MFC: macrophage foam cell; AHA: American Heart Association.