(Stroke. 2000;31:774.)
© 2000 American Heart Association, Inc.
Comments, Opinions, and Reviews |
The Symptomatic Carotid Plaque
From the Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, UK.
Correspondence to J. Golledge, Department of Vascular Surgery, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. E-mail J.Golledge{at}tesco.net
Background—The natural histories of equally severe symptomatic and asymptomatic carotid stenoses are very different, which suggests dichotomy in plaque behavior. The vascular biology of the symptomatic carotid plaque is presented in this review.
Summary of Review—Histology studies comparing asymptomatic and symptomatic plaques were identified from MEDLINE. Reports in which stenosis severity was not stated or not similar for symptomatic and asymptomatic patients were excluded. In vitro studies and reports from the coronary circulation were reviewed with regard to the vascular biology of the plaque. Histology studies comparing carotid plaques removed from symptomatic and asymptomatic patients reveal characteristic features of unstable plaques: surface ulceration and plaque rupture (48% of symptomatic compared with 31% of asymptomatic, P<0.001), thinning of the fibrous cap, and infiltration of the cap by greater numbers of macrophages and T cells. In vitro studies suggest that macrophages and T cells release cytokines and proteinase, which stimulate breakdown of cap collagen and smooth muscle cell apoptosis and thereby promote plaque rupture.
Conclusions—Infiltration of inflammatory cells to the surface of carotid plaques may be a critical step in promoting plaque rupture and resultant embolization or carotid occlusion. Further understanding of cell recruitment and behavior in carotid atherosclerosis may allow better detection of unstable plaques and therapeutic methods of plaque stabilization.
Key Words: atherosclerosis • carotid artery diseases • leukocytes
This article has been cited by other articles:
 |
|
 |
|
  M. Egger, A. Krasinski, B. K. Rutt, A. Fenster, and G. Parraga Comparison of B-Mode Ultrasound, 3-Dimensional Ultrasound, and Magnetic Resonance Imaging Measurements of Carotid Atherosclerosis J. Ultrasound Med., September 1, 2008; 27(9): 1321 - 1334. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Altaf, P. S. Morgan, A. Moody, S. T. MacSweeney, J. R. Gladman, and D. P. Auer Brain White Matter Hyperintensities Are Associated with Carotid Intraplaque Hemorrhage Radiology, July 1, 2008; 248(1): 202 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Mannheim, J. Herrmann, D. Versari, M. Gossl, F. B. Meyer, J. P. McConnell, L. O. Lerman, and A. Lerman Enhanced Expression of Lp-PLA2 and Lysophosphatidylcholine in Symptomatic Carotid Atherosclerotic Plaques Stroke, May 1, 2008; 39(5): 1448 - 1455. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Saam, H. R. Underhill, B. Chu, N. Takaya, J. Cai, N. L. Polissar, C. Yuan, and T. S. Hatsukami Prevalence of American Heart Association type VI carotid atherosclerotic lesions identified by magnetic resonance imaging for different levels of stenosis as measured by duplex ultrasound. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1014 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Y. Tang, S. P. Howarth, S. R. Walsh, M. E. Gaunt, and J. H. Gillard Contralateral Carotid Intraplaque Hemorrhage May Reduce the Predictive Value of Fat-Suppressed T1-Weighted MRI in Symptomatic Carotid Disease Stroke, December 1, 2007; 38(12): e156 - e157. [Full Text] [PDF]
|
|
|
|
|
|
J. Golledge Response to Letter by Tang et al Stroke, December 1, 2007; 38(12): e158 - e159. [Full Text] [PDF]
|
|
|
|
|
|
J. Golledge Asymptomatic Carotid Stenosis Stroke, November 1, 2007; 38(11): e150 - e150. [Full Text] [PDF]
|
|
|
|
|
|
P. Gao, Z.-q. Chen, Y.-h. Bao, L.-q. Jiao, and F. Ling Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms: Systematic Review of Observational Studies Stroke, August 1, 2007; 38(8): 2382 - 2390. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Saba, G. Caddeo, R. Sanfilippo, R. Montisci, and G. Mallarini CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1061 - 1066. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. H. Tonnessen and S. R. Money Redgrave JNE, Lovett JK, Gallagher PJ, et al. Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford Plaque Study. Circulation. 2006; 113:2320-2328 Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 194 - 195. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Marfella, C. Di Filippo, M. D'Amico, and G. Paolisso Diabetes, Ubiquitin Proteasome System and Atherosclerotic Plaque Rupture Circ. Res., May 25, 2007; 100(10): e84 - e85. [Full Text] [PDF]
|
|
|
|
|
|
J. Golledge, S. Mangan, and P. Clancy Effects of Peroxisome Proliferator-Activated Receptor Ligands in Modulating Tissue Factor and Tissue Factor Pathway Inhibitor in Acutely Symptomatic Carotid Atheromas Stroke, May 1, 2007; 38(5): 1501 - 1508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Yamada, M. Higashi, R. Otsubo, T. Sakuma, N. Oyama, R. Tanaka, K. Iihara, H. Naritomi, K. Minematsu, and H. Naito Association between Signal Hyperintensity on T1-Weighted MR Imaging of Carotid Plaques and Ipsilateral Ischemic Events AJNR Am. J. Neuroradiol., February 1, 2007; 28(2): 287 - 292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Saam, J. Cai, L. Ma, Y.-Q. Cai, M. S. Ferguson, N. L. Polissar, T. S. Hatsukami, and C. Yuan Comparison of Symptomatic and Asymptomatic Atherosclerotic Carotid Plaque Features with in Vivo MR Imaging. Radiology, August 1, 2006; 240(2): 464 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Papaspyridonos, A. Smith, K. G. Burnand, P. Taylor, S. Padayachee, K. E. Suckling, C. H. James, D. R. Greaves, and L. Patel Novel Candidate Genes in Unstable Areas of Human Atherosclerotic Plaques Arterioscler Thromb Vasc Biol, August 1, 2006; 26(8): 1837 - 1844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Marfella, M. D'Amico, C. Di Filippo, A. Baldi, M. Siniscalchi, F. C. Sasso, M. Portoghese, O. Carbonara, B. Crescenzi, P. Sangiuolo, et al. Increased Activity of the Ubiquitin-Proteasome System in Patients With Symptomatic Carotid Disease Is Associated With Enhanced Inflammation and May Destabilize the Atherosclerotic Plaque: Effects of Rosiglitazone Treatment J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2444 - 2455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Fiotti, N. Altamura, M. Fisicaro, N. Carraro, L. Uxa, G. Grassi, L. Torelli, R. Gobbato, G. Guarnieri, B. T. Baxter, et al. MMP-9 Microsatellite Polymorphism and Susceptibility to Carotid Arteries Atherosclerosis Arterioscler Thromb Vasc Biol, June 1, 2006; 26(6): 1330 - 1336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Marfella, C. Di Filippo, A. Baldi, M. Siniscalchi, F. C. Sasso, B. Crescenzi, F. Cirillo, G. F. Nicoletti, F. D'Andrea, G. Chiorazzo, et al. The Vascular Smooth Muscle Cells Apoptosis in Asymptomatic Diabetic Carotid Plaques: Role of Glycemic Control J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2118 - 2120. [Full Text] [PDF]
|
|
|
|
 |
|
 J.N.E. Redgrave, J.K. Lovett, P.J. Gallagher, and P.M. Rothwell Histological Assessment of 526 Symptomatic Carotid Plaques in Relation to the Nature and Timing of Ischemic Symptoms: The Oxford Plaque Study Circulation, May 16, 2006; 113(19): 2320 - 2328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Davies, J. H.F. Rudd, P. L. Weissberg, and J. Narula Radionuclide imaging for the detection of inflammation in vulnerable plaques. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C57 - C68. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Aidinian, J. M. Weiswasser, S. Arora, C. J. Abularrage, N. Singh, and A. N. Sidawy Carotid Plaque Morphologic Characteristics Perspectives in Vascular Surgery and Endovascular Therapy, March 1, 2006; 18(1): 63 - 70. [Abstract] [PDF]
|
|
|
|
|
|
I. P. Casserly, A. Abou-Chebl, R. B. Fathi, D. S. Lee, J. Saw, J. E. Exaire, S. R. Kapadia, C. T. Bajzer, and J. S. Yadav Slow-Flow Phenomenon During Carotid Artery Intervention With Embolic Protection Devices: Predictors and Clinical Outcome J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1466 - 1472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J H McCabe, P Harrison, I J Mackie, P S Sidhu, G Purdy, A S Lawrie, H Watt, S J Machin, and M M Brown Increased platelet count and leucocyte-platelet complex formation in acute symptomatic compared with asymptomatic severe carotid stenosis J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1249 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. F. Ameriso, A. R. Villamil, C. Zedda, J. C. Parodi, S. Garrido, M. I. Sarchi, M. Schultz, J. Boczkowski, and G. E. Sevlever Heme Oxygenase-1 Is Expressed in Carotid Atherosclerotic Plaques Infected by Helicobacter pylori and Is More Prevalent in Asymptomatic Subjects Stroke, September 1, 2005; 36(9): 1896 - 1900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Sztajzel, S. Momjian, I. Momjian-Mayor, N. Murith, K. Djebaili, G. Boissard, M. Comelli, and G. Pizolatto Stratified Gray-Scale Median Analysis and Color Mapping of the Carotid Plaque: Correlation With Endarterectomy Specimen Histology of 28 Patients Stroke, April 1, 2005; 36(4): 741 - 745. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Spagnoli, A. Mauriello, G. Sangiorgi, S. Fratoni, E. Bonanno, R. S. Schwartz, D. G. Piepgras, R. Pistolese, A. Ippoliti, and D. R. Holmes Jr Extracranial Thrombotically Active Carotid Plaque as a Risk Factor for Ischemic Stroke JAMA, October 20, 2004; 292(15): 1845 - 1852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Lombardo, L. M. Biasucci, G. A. Lanza, S. Coli, P. Silvestri, D. Cianflone, G. Liuzzo, F. Burzotta, F. Crea, and A. Maseri Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability Circulation, June 29, 2004; 109(25): 3158 - 3163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ghilardi, M. L. Biondi, O. Turri, E. Guagnellini, and R. Scorza Internal Carotid Artery Occlusive Disease and Polymorphisms of Fractalkine Receptor CX3CR1: A Genetic Risk Factor Stroke, June 1, 2004; 35(6): 1276 - 1279. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Fournier, F. H. Messerli, J. M. Achard, and L. Fernandez Cerebroprotection mediated by angiotensin II: A hypothesis supported by recent randomized clinical trials J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1343 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Yamagami, K. Kitagawa, Y. Nagai, H. Hougaku, M. Sakaguchi, K. Kuwabara, K. Kondo, T. Masuyama, M. Matsumoto, and M. Hori Higher Levels of Interleukin-6 Are Associated With Lower Echogenicity of Carotid Artery Plaques Stroke, March 1, 2004; 35(3): 677 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Barr, J. J. Connors III, D. Sacks, J. C. Wojak, G. J. Becker, J. F. Cardella, B. Chopko, J. E. Dion, A. J. Fox, R. T. Higashida, et al. Quality Improvement Guidelines for the Performance of Cervical Carotid Angioplasty and Stent Placement: Developed by a Collaborative Panel of the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, and the Society of Interventional Radiology AJNR Am. J. Neuroradiol., November 1, 2003; 24(10): 2020 - 2034. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Nuotio, P. J. Lindsberg, O. Carpen, L. Soinne, E. M.P. Lehtonen-Smeds, E. Saimanen, R. Lassila, T. Sairanen, S. Sarna, O. Salonen, et al. Adhesion molecule expression in symptomatic and asymptomatic carotid stenosis Neurology, June 24, 2003; 60(12): 1890 - 1899. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Murphy, A. R. Moody, P. S. Morgan, A. L. Martel, G.S. Delay, S. Allder, S. T. MacSweeney, W. G. Tennant, J. Gladman, J. Lowe, et al. Prevalence of Complicated Carotid Atheroma as Detected by Magnetic Resonance Direct Thrombus Imaging in Patients With Suspected Carotid Artery Stenosis and Previous Acute Cerebral Ischemia Circulation, June 24, 2003; 107(24): 3053 - 3058. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Trostdorf, M. Sitzer, B. Chambers, J. Stork, K. Kimura, A. Abbott, C. Levi, and G. Donnan Symptomatic Carotid Artery Stenosis: Heterogeneity of Destabilizing Mechanisms? * Response Stroke, June 1, 2003; 34 (6): e41 - e41. [Full Text] [PDF]
|
|
|
|
|
|
G. Ghilardi, M. L. Biondi, M. DeMonti, O. Turri, E. Guagnellini, and R. Scorza Matrix Metalloproteinase-1 and Matrix Metalloproteinase-3 Gene Promoter Polymorphisms Are Associated With Carotid Artery Stenosis Stroke, October 1, 2002; 33(10): 2408 - 2412. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-J. Geng and P. Libby Progression of Atheroma: A Struggle Between Death and Procreation Arterioscler Thromb Vasc Biol, September 1, 2002; 22(9): 1370 - 1380. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Ghilardi, M. L. Biondi, M. DeMonti, M. Bernini, O. Turri, F. Massaro, E. Guagnellini, and R. Scorza Independent Risk Factor for Moderate to Severe Internal Carotid Artery Stenosis: T786C Mutation of the Endothelial Nitric Oxide Synthase Gene Clin. Chem., July 1, 2002; 48(7): 989 - 993. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Walker, A. Ismail, W. McMeekin, D. Lambert, A. D. Mendelow, and D. Birchall Computed Tomography Angiography for the Evaluation of Carotid Atherosclerotic Plaque: Correlation With Histopathology of Endarterectomy Specimens Stroke, April 1, 2002; 33(4): 977 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.Y. Streifler, N. Rosenberg, A. Chetrit, R. Eskaraev, B.A. Sela, R. Dardik, A. Zivelin, B. Ravid, J. Davidson, U. Seligsohn, et al. Cerebrovascular Events in Patients With Significant Stenosis of the Carotid Artery Are Associated With Hyperhomocysteinemia and Platelet Antigen-1 (Leu33Pro) Polymorphism Stroke, December 1, 2001; 32(12): 2753 - 2758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Liapis, J. D. Kakisis, and A. G. Kostakis Carotid Stenosis: Factors Affecting Symptomatology Stroke, December 1, 2001; 32(12): 2782 - 2786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. G. Nadareishvili, D. E. Koziol, B. Szekely, C. Ruetzler, R. LaBiche, R. McCarron, T. J. DeGraba, and S. Jander Increased CD8+ T Cells Associated With Chlamydia pneumoniae in Symptomatic Carotid Plaque Editorial Comment Stroke, September 1, 2001; 32(9): 1966 - 1972. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Jander, M. Sitzer, A. Wendt, M. Schroeter, M. Buchkremer, M. Siebler, W. Muller, W. Sandmann, and G. Stoll Expression of Tissue Factor in High-Grade Carotid Artery Stenosis : Association With Plaque Destabilization Stroke, April 1, 2001; 32(4): 850 - 854. [Abstract] [Full Text] [PDF]
|
|