What makes plaques vulnerable to rupture?
The combination of increased mechanical stress on the fibrous cap and weakening of the fibrous cap extracellular matrix leads to plaque rupture. A cascade of events leads to plaque rupture. Accumulation of lipid in the lesion leads to dramatically increased stress on the fibrous cap of the lesion.
What is the difference between plaque erosion and plaque rupture?
Rupture is the disruption of a fibrous cap over a lipid core; erosion is the superficial disruption of a fibromuscular plaque without a core.
What does plaque erosion mean?
Plaque erosion is defined as an acute thrombus in direct contact with the intima in an area of denuded endothelium. Thus, plaque events ensue as a result of an intimal fibroatheroma in the coronary artery wall becoming vulnerable to erosion or rupture.
What happens when a plaque membrane ruptures?
Plaque rupture results in circulatory exposure of its thrombogenic contents (e.g., tissue factor, collagens, and lipids) leading to thrombus formation and MI [312,313]. Previous studies have indicated an association between increased MMP-3 expression and plaque rupture [43,146].
When is a plaque more likely to rupture?
Rupture of the plaque surface, often with thrombosis superimposed, occurs frequently during the evolution of coronary atherosclerotic lesions. It is probably the most important mechanism underlying the sudden, rapid plaque progression responsible for acute coronary syndromes.
How are vulnerable plaques treated?
Local treatment of vulnerable plaques by percutaneous coronary intervention and systemic treatment with anti-inflammatory and low-density lipoprotein–lowering drugs are currently being investigated in large randomized clinical trials to assess their therapeutic potential for reducing adverse coronary events.
Which plaque is most prone to rupture?
Plaque rupture occurs where the cap is thinnest and most infiltrated by foam cells (macrophages). In eccentric plaques, the weakest spot is often the cap margin or shoulder region,86 and only extremely thin fibrous caps are at risk of rupturing.
How do you prevent plaque from bursting?
Aggressive cholesterol reduction and control of factors which produce endothelial injury and contribute to the development and progression of atherosclerosis such as smoking and hypertension, and prevention of intravascular thrombosis such as aspirin, may prevent plaque rupture, intravascular thrombosis and acute …
What is ulcerated plaque?
Carotid plaque ulceration or surface irregularity is characterized as an indentation, fissure, or erosion on the luminal surface of a plaque, exposing a portion of the inner plaque to direct contact with the circulating blood.
What is atheroma made up of?
Atheromas are raised lesions that protrude into the vessel lumen and contain a soft, yellow, grumous (thick and lumpy) core consisting mainly of cholesterol and cholesterol esters, covered by a white, fibrous cap.
What happens when unstable plaque rupture?
Similarly, the rupture of unstable atherosclerotic plaques is a complex process ultimately representing a maladaptive response to hemodynamic conditions, lipid accumulation, arterial injury, necrosis, and inflammation.
How can you tell if a plaque is vulnerable?
Four technologies are under study as methods to identify vulnerable carotid plaque: ultrasound, MRI, nuclear imaging, and x-ray multidetector computed tomography (MDCT).
What is the difference between vulnerable and erosion-prone plaques?
Advanced plaques, including those that appear vulnerable, are in general hypocellular and consist mainly of fibrous tissue, necrosis, and calcifications ( Cheruvu et al., 2007; Falk, 2006 ). Thus, in contrast to vulnerable plaques of the rupture-prone type, detection of the erosion-prone type by imaging remains a challenge.
What is the meaning of vulnerable plaque?
Vulnerable or high-risk plaque refers to coronary artery atherosclerotic lesions with features associated with future acute coronary events, independent of luminal stenosis.
What are rupture-prone plaque matrix metalloproteinases?
The Rupture-Prone Plaque Matrix metalloproteinases are a family of proteolytic enzymes produced by several cell types, including monocyte/macrophages and activated T cells. These enzymes degrade the extracellular matrix.
Where can I get information about vulnerable plaques?
1 Dept. of Cardiovascular Pathology, Armed Forces Institute of Pathology, 6825 16th Street, N.W., Washington, DC 20306-6000, USA. [email protected] Vulnerable plaques have been defined as precursors to lesions that rupture.
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