open access

Vol 25, No 3 (2019)
Review papers
Published online: 2019-09-30
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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

Natalia Wiśniewska, Emil Kania, Adam Płoński, Jerzy Głowiński
DOI: 10.5603/AA.2019.0013
·
Acta Angiologica 2019;25(3):145-156.

open access

Vol 25, No 3 (2019)
Review papers
Published online: 2019-09-30

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).

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).

Get Citation

Keywords

endothelium, carotid artery, atherosclerotic plaque, plaque instability, stroke

About this article
Title

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

Journal

Acta Angiologica

Issue

Vol 25, No 3 (2019)

Pages

145-156

Published online

2019-09-30

DOI

10.5603/AA.2019.0013

Bibliographic record

Acta Angiologica 2019;25(3):145-156.

Keywords

endothelium
carotid artery
atherosclerotic plaque
plaque instability
stroke

Authors

Natalia Wiśniewska
Emil Kania
Adam Płoński
Jerzy Głowiński

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