Carotid Artery Disease and the Risk of Ischaemic Stroke and Coronary Vascular Events

Abstract

Information on the presence and extent of carotid arterial wall disease has significant prognostic value. Carotid artery stiffness, intima-media thickness, and early plaque formation are potentially useful predictors of the risk of both ischaemic stroke and coronary heart disease in asymptomatic populations. Early carotid arterial wall disease is also a useful predictor of coronary artery disease on angiography and subsequent coronary vascular events in populations at risk of coronary heart disease. More advanced carotid wall disease (carotid stenosis and plaque surface morphology) is predictive of both ischaemic stroke and coronary heart disease in high-risk populations with established cerebrovascular disease. Plaque characteristics on ultrasound, such as echolucency, may also have a prognostic value. However, in order to identify individuals with high risks of vascular events, this information must be combined with other clinical, laboratory, and imaging data. Ideally, large prospective cohort studies are required in which all these data are recorded and then combined using multivariate statistical modelling. Future studies should also determine the relationship between the various measures of carotid wall disease and the risk of stroke for the different subtypes of ischaemic stroke.

Genetic control of chemokines in severe human internal carotid artery stenosis

“…Rupture of atherosclerotic plaques is crucial in the pathogenesis of acute coronary syndromes and strokes [20,21]. Interactions, within the ICA stenosing plaque, between connective tissue and the cells embedded into the fibrous cap overlying the inner core appear to determine the history of the ICA stenosis: plaque rupture or ulceration, intraplaque haemorrhage and luminal thrombosis are recognized causes of stroke [20,21].…”

“…Interactions, within the ICA stenosing plaque, between connective tissue and the cells embedded into the fibrous cap overlying the inner core appear to determine the history of the ICA stenosis: plaque rupture or ulceration, intraplaque haemorrhage and luminal thrombosis are recognized causes of stroke [20,21]. Specific markers to identify in vivo ruptured plaques, or plaques prone to rupture, are not available.…”

The Management of Peripheral Arterial Disease (PAD) in Primary Care

“…With an aging global population, this is expected to continue and the burden on healthcare systems from cardiovascular disease is expected to rise. Vascular disease in one arterial territory predicts the presence of disease in other territories (Rothwell, 2000). The risk of a myocardial infarction or death increases significantly after a transient ischemic attack or stroke (Touze et al, 2005).…”

The Use of Plaque Score Measurements to Assess Changes in Atherosclerotic Plaque Burden Induced by Lipid-Lowering Therapy Over Time: The METEOR Study

“…As for CIMT, the presence of atherosclerotic plaque in the carotid artery has consistently been associated with cardiovascular risk factors and with prevalent and incident vascular events [4][5][6][7][8][9][10][11][12][13][14][15] . Moreover, measurement of changes in plaque volume may be of value in assessing changes in atherosclerotic burden over time, as some studies have found a stronger association with vascular events for plaques than for CIMT 4,5,7,11,13) .…”