Pathology of Atherosclerosis and Stenting

Abstract

Atherosclerotic plaque at the carotid bifurcation is the primary cause of ischemic strokes and the degree of carotid stenosis is strongly associated with stroke risk in symptomatic patients. Stroke is the third-leading cause of death in the United States, constituting approximately 700,000 cases each year. In this article, the authors discuss the natural history of carotid and intracranial atherosclerosis, based on their broader knowledge of coronary atherosclerosis. Early to more advanced progressive lesions of the carotid are categorized, based on descriptive morphologic events originally cited for the coronary circulation. The histologic features associated with symptomatic and asymptomatic carotid disease are also addressed, along with the issues surrounding current stent-based therapies for the prevention of major recurrent vascular events.

Pathological Quantification of Carotid Artery Plaque Instability in Patients Undergoing Carotid Endarterectomy

“…52 Furthermore, Kolodgie et al described extensive inflammation as an important risk factor of restenosis after CAS. 21 In our study, age and the thickness of calcification were positively correlated ( Figure S2). Infiltration of inflammatory cells, as well as foamy and hemosiderin-laden macrophages, was less observed in patients with NC <120° than in those with NC ≥120° (Table S3).…”

18F-FDG PET/CT for the quantification of inflammation in large carotid artery plaques

“…Compared to a solid tumor, the cells responsible for 18 F-FDG uptake in carotid artery plaques are generally fewer, more dispersed, and spread around parts of the circumference of a tubular vascular structure. 3,7 Consequently, limited spatial resolution of the PET scanner and blood background activity are of great concern. Two parallel phenomena are known to influence measured activity in a lesion: 8 signal from the lesion lost to the surroundings (spill-out), and signal added to the lesion from the vessel lumen and adjacent anatomic structures (spill-in).…”

Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review

“…These plaques contain Lipid-Rich Necrotic Core (LRNC), which is enclosed by depleted smooth muscle cells and a thin fibrous cap [76]. Thinning of these fibrous cap is a distinct risk indicator for underlying or forthcoming ischemic neurological abnormalities [77,78]. Emboli or thrombus may break off, due to artery wall stress, from plaque having a thin fibrous cap and join the blood circulation towards the brain [79].…”