Vol 25, No 3 (2019)
Review paper
Published online: 2019-09-30
Pathogenesis regarding development and structure of unstable atherosclerotic plaque in internal carotid artery in relation to high risk factors of an ischaemic stroke. Current status of knowledge
DOI: 10.5603/AA.2019.0013
Acta Angiologica 2019;25(3):145-156.
Abstract
Worldwide, stroke is the second leading cause of death and a major cause of disability . However, the mortality
of stroke differs between countries and geographical regions. In high-income countries, i.e. in the United States,
stroke has fallen from the third to the fourth leading cause of death. The risk for ischaemic stroke increases
with the degree of internal carotid artery stenosis. 70–99% carotid artery stenosis (according to NASCET)
in symptomatic patients is an indication for a vascular intervention since this group will achieve significant
benefits from surgical treatment. Asymptomatic patients with 60–99% (according to NASCET) carotid artery
stenosis may also benefit from surgical procedures when at least one-factor conditioning a high risk of ischaemic
stroke incidence exists. These factors may include morphological structure features of atherosclerotic plaque
described in imaging examinations that are indicative of its instability and specific clinical predispositions. The
paper presents stages of unstable atherosclerotic plaque development and features of its morphological structure
that may significantly increase the risk for ischaemic stroke and compares them with current guidelines:
Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the
European Society for Vascular Surgery (ESVS).
Keywords: endotheliumcarotid arteryatherosclerotic plaqueplaque instabilitystroke
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