The unstable plaque
The unstable plaque
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DOI：
10.1159/000075300
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发表时间：
2004-01-01
影响因子：
2.9
通讯作者：
Hennerici, MG
中科院分区：
文献类型：
--
作者：
Hennerici, MG
缺血性中风和短暂性脑缺血发作通常由脑栓塞引起，脑栓塞源于动脉粥样硬化斑块上叠加的富血小板血栓形成或颈动脉或颅内动脉中的动脉粥样硬化血栓斑块破裂。尽管通过超声成像在我们对动脉粥样硬化斑块进展和消退的理解方面取得了进展，但斑块结构的差异是否可以单独区分有症状的病变和其他临床上保持沉默的病变仍然存在争议。最近的生物化学和影像学研究已经确定了可能反映易损性高风险的特征，如外向、腔外斑块重塑、斑块内出血、炎症、侵入病变周围严重的血流紊乱、斑块帽变薄和溃疡以及斑块运动异常。通过控制传统的心血管危险因素或使用靶向斑块病理生理学通路的生物或药理学药物，可以改善斑块的稳定性。不稳定斑块使患者处于不可预测的缺血事件的风险中，在具有此类病变的患者中，可以使用长期抗血小板治疗以外的特定预防性治疗来预防新的或复发的事件。版权所有（C）2004 S. Karger AG，巴塞尔。
Ischaemic strokes and transient ischaemic attacks are commonly caused by cerebral embolism originating from formation of a platelet-rich thrombus superimposed on an atherosclerotic plaque or by atherothrombotic plaque rupture in a carotid or intracranial artery. Despite advances made through ultrasound imaging in our understanding of atherosclerotic plaque progression and regression, the issue of whether differences in plaque structure alone can distinguish between lesions that become symptomatic and others that remain clinically silent continues to be debated. Recent biochemical and imaging studies have identified characteristics that may reflect a high risk of vulnerability, such as outward, abluminal plaque remodelling, the presence of intraplaque haemorrhage, inflammation, severe flow disturbances around the encroaching lesion, plaque cap thinning and ulceration, and abnormal plaque motion. Plaque stability may be improved through management of traditional cardiovascular risk factors or with biological or pharmacological agents that target pathways involved in plaque pathophysiology. Unstable plaques place patients at risk of unpredictable ischaemic events and in patients with such lesions, specific preventive treatment beyond long-term antiplatelet therapy can be used to prevent new or recurrent events. Copyright (C) 2004 S. Karger AG, Basel.