The role of vasa vasorum in carotid stenosis

Carotid stenosis is a significant health concern, characterized by the narrowing of the internal carotid artery due to atherosclerotic plaque formation. It represents a major risk factor for ischemic stroke, which is remaining a leading cause of disability and mortality worldwide. The development and progression of atherosclerosis within the vascular wall involve the intricate interplay of several factors, including, in particular, the role of "vessels of the vessels" or "vasa vasorum." Vasa vasorum are small blood vessels that play a crucial role in nourishing the walls of larger blood vessels, including the carotid arteries. Over the years, emerging evidence has suggested that vasa vasorum's involvement in atherosclerosis goes beyond a mere nutritional function. Dysfunctional vasa vasorum have been associated with intraplaque hemorrhage, local inflammation and atherosclerotic plaque destabilization, ultimately leading to stroke. The relationships between vasa vasorum functionality and carotid stenosis is becoming an active area of research in the field of clinical complications of atherosclerosis. This review aims to explore the current state of knowledge regarding the role of vasa vasorum in carotid stenosis and the potential implications for its risk stratification, diagnosis, and treatment.