Arve Dahl1, Christian Lund, David Russell. 1. Cerebrovaskulaer seksjon, Nevrologisk avdeling, Nevroklinikken, Rikshospitalet-Radiumhospitalet, 0027 Oslo. arve.dahl@rikshospitalet.no
Abstract
BACKGROUND: Approximately half of all cerebral infarctions are caused by artery-to-artery emboli from atherosclerotic plaques in the aorta and pre- or intracranial arteries. This review article presents an update on the development of atherosclerotic plaques, and discusses the diagnostic and therapeutic implications of new pathophysiological knowledge of atherosclerosis in relation to cerebral infarction. MATERIAL AND METHODS: The article is based on our own clinical-neurological experience and publications mainly on intima-media thickness (IMT) and ultrasound in the diagnosis of cerebrovascular disease, identified through a Medline search. RESULTS: Unstable plaques have a thin and vulnerable capsule, inflammatory cells, high fat content and often intra-plaque bleeding. Calcium deposition and organized fibrous tissue have a stabilizing effect. The development of atherosclerosis and biological characteristics of plaques can be explained by known vascular risk factors and genetic disposition. Ultrasound examination of the aorta and pre-cerebral arteries can be used to assess the degree of atherosclerosis and to provide important information regarding patients' risk of cerebrovascular disease. INTERPRETATION: New knowledge regarding the pathophysiology of atherosclerosis can improve prediction of a patient's risk for ischemic stroke. This forms the basis for a better and more individualized prophylactic treatment of cerebrovascular disease.
BACKGROUND: Approximately half of all cerebral infarctions are caused by artery-to-artery emboli from atherosclerotic plaques in the aorta and pre- or intracranial arteries. This review article presents an update on the development of atherosclerotic plaques, and discusses the diagnostic and therapeutic implications of new pathophysiological knowledge of atherosclerosis in relation to cerebral infarction. MATERIAL AND METHODS: The article is based on our own clinical-neurological experience and publications mainly on intima-media thickness (IMT) and ultrasound in the diagnosis of cerebrovascular disease, identified through a Medline search. RESULTS: Unstable plaques have a thin and vulnerable capsule, inflammatory cells, high fat content and often intra-plaque bleeding. Calcium deposition and organized fibrous tissue have a stabilizing effect. The development of atherosclerosis and biological characteristics of plaques can be explained by known vascular risk factors and genetic disposition. Ultrasound examination of the aorta and pre-cerebral arteries can be used to assess the degree of atherosclerosis and to provide important information regarding patients' risk of cerebrovascular disease. INTERPRETATION: New knowledge regarding the pathophysiology of atherosclerosis can improve prediction of a patient's risk for ischemic stroke. This forms the basis for a better and more individualized prophylactic treatment of cerebrovascular disease.