Intraplaque neovascularization and bleeding play a major role in plaque progression and may serve as a measure of risk for the development of future atherothrombotic events.
Atherothrombosis remains one of the main causes of morbidity and mortality in the western countries. Human atherothrombotic disease begins early in life in relation to circulating lipid retention in the inner vascular wall. Risk factors enhance the progression towards clinical expression: dyslipidaemia, diabetes, smoking, hypertension, ageing, etc. The evolution from the initial lipid retention in the arterial wall to clinical events is a continuum of increasingly complex biological processes. Current strategies to fight the consequences of atherothrombosis are orientated either towards the promotion of a healthy life style and preventive treatment of risk factors, or towards late interventional strategies. Despite this therapeutic arsenal, the incidence of clinical events remains dramatically high, dependent, at least in part, on the increasing frequency of type 2 diabetes and ageing. But some medical treatments, focusing only on prevention of the metabolic risk, have failed to reduce cardiovascular mortality, thus illustrating that our understanding of the pathophysiology of human atherothrombosis leading to clinical events remain incomplete. New paradigms are now emerging which may give rise to novel experimental strategies to improve therapeutic efficacy and prediction of disease progression. Recent studies strengthen the concept that the intraplaque neovascularization and bleeding (Figure 1, upper panel) are events that could play a major role in plaque progression and leucocyte infiltration, and may also serve as a measure of risk for the development of future events. The recent advances in our understanding of IntraPlaque Hemorrhage as a critical event in triggering acute clinical events have important implications for clinical research and possibly future clinical practice.
“The best predictor of which patient had a stroke was the presence of complex carotid plaque with evidence of hemorrhage or bleeding into it. We found that this imaging finding performed better than any other clinical marker as to whether the patient had a stroke on a certain side of their brain. So, this study corroborated with in vivo evidence the ongoing theories of what leads to a stroke or heart attack.”
Michel et al. (Sat,) conducted a review in Atherothrombosis. Intraplaque neovascularization and bleeding play a major role in plaque progression and may serve as a measure of risk for the development of future atherothrombotic events.