Recent insights into the pathophysiology and implications for surgery in atherosclerosis

Figures

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  Fig. 1. The formation of remnant lipoprotein and the latest reverse cholesterol transport model. During triglyceride hydrolysis, HDL acquires lipids and apolipoproteins from VLDL, initiating its formation. HDL facilitates reverse cholesterol transport (RCT) by promoting cholesterol efflux from macrophages via transporters ABCA1, ABCG1, and SR-BI. In addition to classical LCAT-mediated esterification and hepatic uptake, recent evidence highlights the direct transfer of free cholesterol (FC) between macrophages, HDL, and hepatocytes. Thus, HDL functionality—particularly FC bioavailability—may be more critical than HDL quantity in protecting against atherosclerosis

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  Fig. 2. The pathophysiology of atherosclerosis. Lipoproteins retained in the endothelial extracellular matrix undergo oxidation by reactive oxygen species (ROS), forming oxLDL that triggers T cell–mediated autoimmune responses and endothelial injury. Endothelial activation promotes monocyte adhesion and infiltration, leading to macrophage differentiation and foam cell formation. Foam cells and smooth muscle cells propagate inflammation, oxidative stress, and extracellular matrix remodeling, ultimately resulting in plaque progression and vascular calcification

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  Fig. 3. Lesion morphology appearance with intravascular imaging. From: Courtesy of the review “Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Universal Approach for Optimization of Stent Implantation” by Shlofmitz, E., Ali, Z. A., Maehara, A., Mintz, G. S., Shlofmitz, R., & Jeremias, A., Circulation, Cardiovascular Interventions

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  Fig. 4. Definition of the coronary tree-segments. All from: Courtesy of the paper “The SYNTAX Score: An angiographic tool grading the complexity of coronary artery disease” by Sianos Georgios., Morel Marie-Angèle., Kappetein Arie Pieter., Morice Marie-Claude., Colombo Antonio., Dawkins Keith., van den Brand Marcel., Van Dyck Nic., Russell Mary E., Mohr Friedrich W., Serruys Patrick W., EuroIntervention