Key result
Plaque disruption and intraplaque hemorrhage occur significantly more frequently in symptomatic compared with asymptomatic carotid endarterectomy specimens, suggesting they initiate symptoms.
Plaque disruption and intraplaque hemorrhage are key mechanisms in the transition of asymptomatic carotid atherosclerosis to symptomatic disease, drawing parallels to coronary artery pathology.
May inform carotid risk stratification; leaves open whether targeting intraplaque hemorrhage prevents symptoms.
The event or mechanism that causes an asymptomatic atherosclerotic carotid artery to become symptomatic remains uncertain. Analysis of carotid endarterectomy surgical specimens from symptomatic patients has suggested that primary intraplaque hemorrhage is the most important initiating event. Reanalysis of several recent series of carotid endarterectomy specimens demonstrated that plaque disruption (ulceration) occurs as frequently as plaque hemorrhage, and that both processes are significantly more frequent in symptomatic as compared with asymptomatic endarterectomy specimens. A review of the coronary artery pathology literature reveals that plaque disruption is commonly present in patients with acute fatal myocardial infarction. It is widely asserted that coronary artery plaque disruption leads to luminal thrombosis and intraplaque hemorrhage. A similar sequence of events may occur in symptomatic carotid arteries.
No takes yet. Share an insight, caveat, or question.
Fisher et al. (1987) conducted a review in Atherosclerotic carotid artery disease. Plaque disruption (ulceration) and intraplaque hemorrhage vs. Asymptomatic carotid arteries was evaluated on Frequency of plaque disruption and hemorrhage in symptomatic vs asymptomatic endarterectomy specimens. Plaque disruption and intraplaque hemorrhage occur significantly more frequently in symptomatic compared with asymptomatic carotid endarterectomy specimens, suggesting they initiate symptoms.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: