The formation of atherosclerotic plaque, its destabilisation and diagnostics

1 Clinic for Endocrine, General and Vascular Surgery, Copernicus Memorial Hospital, Lodz, Poland
2 Clinic for Neurology and Epileptology with the Stroke Unit, Medical University of Lodz, Poland
3 Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Poland
Correspondence to:Clinic for Endocrine, General and Vascular Surgery, Copernicus Memorial Hospital, Pabianicka 62, 93-513 Lodz, e-mail: ave151@wp.pl
The preparation of this manuscript was supported by the Medical University of Lodz (Research Task No. 502-03/5-062-01/502-54-111)
The contribution of the work of the author of the first and the second was equivalent

AKTUALN NEUROL 2014, 14 (1), p. 43–53
DOI: 10.15557/AN.2014.0005
ABSTRACT

According to the established medical knowledge, the atheromatous lesions occur in the arteries of large and medium diameter. Their presence in the aorta, arteries of extremities as well as extracerebral and coronal arteries is clinically relevant. The evolution of atherosclerotic plaques probably starts in the prenatal development, what may be proved by the presence of the fatty streaks in endothelium of coronal arteries in some newborns. Then it evolves through lipid accumulation, media inflammatory response, vasa vasorum proliferation, fibrination and calcification of plaques. Researches proved that the matter of atherosclerosis is exaggerated inflammatory proliferative reaction to the arterial wall damage. The oxidative stress phenomenon and infections with common pathogens play an undoubtful role in this process. Ultimately the direct damage is an effect of immune response cells infiltration and secretion of cytokines and proinflammatory factors. Among the cells of immune system responsible for formation and development of atheromatous plaque are considered: macrophages, dendritic cells, T and B lymphocytes, monocytes. Attention was also paid to the inflammatory mediators and growth factors. Scientist are interested in unstable atherosclerotic plaque and accompanying inflammatory process within the artery wall for a long time. Meanwhile, there are conducted researches on inflammation markers underlying the destabilisation of plaques. Revealing the role of these cells in evolution of atherosclerosis would enable more complex understanding of the mechanism of lesions development. Then it would facilitate an introduction of the new and upgraded methods of treatment and prevention. Also the progress of imaging examinations is meaningful for diagnostics and treatment. It is contributory to the choice of therapeutic strategy and assessment of surgical intervention urgency. In the clinical practice there are recognized standards of imaging the morphology of atheromatous plaque. Development of diagnostics aims the indirect assessment of possible dynamics of lesions progression. Targeting the complex plaque analysis is based on excellence of established standards such as ultrasound examination or computed tomography.

Keywords: atherosclerosis, atheromatous/atherosclerotic plaque, inflammation, mediator, immune response cells, unstable plaque, diagnostics, imaging