Interleukin (IL)-18 plays a central role in the inflammatory cascade. We immunohistochemically assessed specimens obtained by directional coronary atherectomy (DCA) from patients with stable and unstable angina to determine whether IL-18 expression in coronary atherosclerotic lesions is related to plaque instability. We detected IL-18 immunoreactivity in coronary culprit plaques, especially in macrophages. More areas were immunopositive for IL-18 in DCA specimens from patients with unstable angina than in those with stable angina and IL-18 expression was increased in plaques containing thrombus. Furthermore, IL-18 expression significantly correlated with IFN-ホウ expression. These findings suggest that IL-18 is involved in the pathogenesis of plaque instability in human coronary arteries.