High-risk carotid plaque: lessons learned from histopathology
High-risk carotid plaque: lessons learned from histopathology
复制标题
DOI：
10.1053/j.semvascsurg.2017.04.008
复制
发表时间：
2017-03-01
影响因子：
2.5
通讯作者：
Virmani, Renu
中科院分区：
文献类型：
--
作者：
Kolodgie, Frank D.;Yahagi, Kazuyuki;Virmani, Renu
动脉粥样硬化性颈动脉疾病的病理生理学和自然史是基于在冠状动脉中进行的研究中获得的更广泛的病变进展知识，这些将被审查。虽然导致颈动脉斑块易损性和脑血管事件的病变进展的精确顺序仍然不太清楚，但与卒中风险相关的特定早期和更晚期进展性病变形态已被表征。最近，有意识地努力预防有症状和无症状患者的卒中，以超越管腔狭窄作为预测未来脑血管事件的唯一指导。推动这一战略的是最近的进展，在医学成像模式，以评估颈动脉粥样硬化的脆弱性，特别是涉及分子成像，这是现在定位在最前沿，以提供更详细和机械评估中风的风险。因此，我们将重点关注有症状和无症状颈动脉疾病患者中高危颈动脉斑块的病理学，并进一步参考最近的机制见解，包括公认的巨噬细胞介导的炎症变化，斑块内新生血管生成/出血，缺氧和微钙化，作为卒中风险的潜在形态学指标。(C)2017爱思唯尔公司All rights reserved.
The pathophysiology and natural history of atherosclerotic carotid disease is predicated on 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 microcalcification, as potential morphologic indicators of stroke risk. (C) 2017 Elsevier Inc. All rights reserved.