High-Risk Carotid Plaque: Lessons Learned from Histopathology

Abstract The pathophysiology and natural history of atherosclerotic carotid disease is predicated upon a more extensive knowledge of lesion progression gained in the studies conducted in the coronary arteries, and these will be reviewed. While the precise sequence of lesion progression leading to ca...

Full description

Saved in:
Bibliographic Details
Published in:Seminars in vascular surgery 2017-03, Vol.30 (1), p.31-43
Main Authors: Kolodgie, Frank D., PhD, Yahagi, Kazuyuki, MD, Romero, Maria E., MD, Trout, Hugh H., MD, Finn, Aloke V., MD, Virmani, Renu, MD
Format: Article
Language:English
Subjects:
Asymptomatic Diseases
Carotid Arteries - diagnostic imaging
Carotid Arteries - pathology
Carotid Arteries - physiopathology
Carotid Artery Diseases - complications
Carotid Artery Diseases - diagnostic imaging
Carotid Artery Diseases - pathology
Carotid Artery Diseases - physiopathology
Disease Progression
Fibrosis
Hemodynamics
Humans
Molecular Imaging - methods
Necrosis
Plaque, Atherosclerotic
Predictive Value of Tests
Prognosis
Regional Blood Flow
Risk Assessment
Risk Factors
Rupture, Spontaneous
Severity of Illness Index
Stroke - etiology
Surgery
Vascular Calcification - diagnostic imaging
Vascular Calcification - pathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract The pathophysiology and natural history of atherosclerotic carotid disease is predicated upon a more extensive knowledge of lesion progression gained in the studies conducted in the coronary arteries, and these will be reviewed. While the precise sequence of lesion progression leading to carotid plaque vulnerability and cerebrovascular events remain less well understood, specific early and more advanced progressive lesion morphologies associated with stroke risk have been characterized. Of late, there has been a conscious effort for stroke prevention in symptomatic and asymptomatic patients to move beyond luminal stenosis as the only guidance to predict future cerebrovascular events. Driving this strategy are recent advances in medical imaging modalities to assess carotid atherosclerosis vulnerability particularly involving molecular imaging, which is now positioned at the forefront to provide a more detailed and mechanistic assessment of stroke risk. As such, we will spotlight the pathology of high-risk carotid plaques in patients with symptomatic and asymptomatic carotid disease with further reference into more recent mechanistic insights involving a recognized macrophage-mediated inflammatory change, intraplaque neoangiogenesis/hemorrhage, hypoxia, and micro-calcification, as potential morphologic indicators of stroke risk.
ISSN:0895-7967
1558-4518
DOI:10.1053/j.semvascsurg.2017.04.008