Materiały źródłowe

• #1 Carotid artery stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1205

  Carotid artery stenosis is a narrowing of the lumen of the carotid artery. Approximately 10% to 15% of all ischemic strokes are associated with carotid artery stenosis. […] Atherosclerotic plaque in the cervical carotid artery is the most common cause. Plaque disruption and atheroembolization into the intracranial circulation is the most common mechanism for stroke. […] The unique hemodynamics at the carotid bifurcation predisposes this area to atherosclerosis. A small percentage of plaques may rupture and embolize to occlude intracranial arteries, causing a transient ischemic attack or stroke, or occlude retinal arteries to cause transient monocular blindness (amaurosis fugax) or retinal strokes.

• #1 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  Carotid stenosis is an important contributor to ischemic stroke risk with resultant significant impact on neurological disability and death in adults and with worldwide implications. […] Understanding of the pathogenesis of carotid atherosclerosis or stenosis is important in management of carotid stenosis. Atherosclerotic plaque formation is a chronic insidious process with a number of potential contributors to the formation of such a plaque. The definition of atherosclerosis is not simply limited to abnormal deposition of lipid but also includes a chronic, complex, inflammatory process. Molecularly, in atherosclerosis, there is decreasing nitric oxide (NO) bioavailability, activity and/or expression of endothelial NO synthase, or increasing degradation of NO secondary to enhanced superoxide production. These above changes cause endothelial dysfunction leading to formation of foam cell followed by formation on lipid plaque. After lipid plaque formation, stable or unstable atherosclerotic plaque is formed depending on the calcium deposition over the lipid plaque.

• #1 Pathophysiology and Medical Treatment of Carotid Artery Stenosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4572017/

  CAS is a progressive narrowing of the carotid artery due to development of atherosclerosis, characterized by local thickening of the interior arterial wall. […] Pathogenesis of atherosclerosis has been reviewed early by Prasad. Classical types of lesion are fatty streaks, fibrous cap, and complicated lesion, based on the progression of atherosclerosis. Carotid plaques consist of lipid core with infiltration of inflammatory cells covered with a fibrous cap. A typical fibrous cap consists of the following: (1) fibrous cap composed of smooth muscle cells, few leukocytes, dense connective tissue that contains elastin, collagen fibrils, proteoglycans, and a basement membrane; (2) a cellular area beneath that consists of a mixture of macrophages, smooth muscle cells, and T lymphocytes; and (3) a deeper necrotic core that contains cellular debris, lipids, cholesterol crystals, and calcium deposit. With time the plaque can become large and produce narrowing in the carotid artery. A plaque can be stable and asymptomatic or it may be a source of embolization.

• #1 A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism

  https://atm.amegroups.org/article/view/72884/html

  Atherosclerotic carotid artery stenosis causes about 1020% of all ischemic strokes through two main mechanisms: hemodynamic impairment in case of significant stenosis and thromboembolism from an atherosclerotic plaque regardless of the degree of stenosis. […] While it is likely that some ischemic strokes associated with carotid artery disease result from hypoperfusion, the majority of such strokes appear to result from embolization from a vulnerable atherosclerotic plaque or acute occlusion of the carotid artery and propagation of thrombus distally. […] These data suggest that hemodynamic impairment may play a role in the occurrence of stroke in patients with carotid stenosis. […] Beyond the degree of stenosis and its potential hemodynamic impairment, carotid plaques, especially vulnerable plaques, cause mostly downstream ischemic stroke through a microembolic mechanism.

• #1 Atherosclerotic Disease of the Carotid Artery: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/463147-overview

  Atherosclerosis is a diffuse, degenerative disease of the arteries that results in the formation of plaques composed of necrotic cells, lipids, and cholesterol crystals. […] Currently, embolization is considered the most common mechanism causing ischemic strokes from atherosclerotic lesions in the carotid bulb. Thrombosis and low flow are other possible mechanisms. […] Stroke is one of the most devastating complications of carotid stenosis. However, carotid stenosis is not the only cause of stroke. In fact, among patients with asymptomatic stenosis of 60-99%, as many as 45% of strokes may be caused by lacunar infarcts or cardiac emboli.

• #1 Carotid artery stenosis and coronary artery disease coincidence

  https://rcm.mums.ac.ir/article_4043.html

  Atherosclerosis risk factors include age, sex (male gender), family history of CAD, hypertension (HTN), dyslipidemia, smoking, diabetes mellitus, and obesity. CAD and carotid artery disease have same risk factors, which are divided to the modifiable and non-modifiable risk factors. […] Overall, CAD and CS have similar occlusion timing.

• #1 Micronanoplastics found in artery-clogging plaque in the neck | Nasdaq

  https://www.nasdaq.com/press-release/micronanoplastics-found-artery-clogging-plaque-neck-2025-04-22

  A small study found that fatty buildup in the blood vessels of the neck (carotid arteries) may contain 50 times or more micronanoplastics — minuscule bits of plastic — compared to arteries free of plaque buildup. Plaque, the fatty deposits that can narrow the carotid artery, may cause a stroke. […] People with plaque in the blood vessels of their neck have a higher amount of tiny plastic particles in those vessels compared to people with healthy arteries. This increase was significantly higher in people who had experienced a stroke, mini-stroke or temporary loss of vision due to clogged blood vessels, according to preliminary research presented at the American Heart Association’s Vascular Discovery 2025 Scientific Sessions: From Genes to Medicine, April 22-25 in Baltimore. […] In 2024, researchers in Italy reported finding micronanoplastics in plaque from some people without symptoms who underwent surgery to remove carotid artery plaque. Symptoms caused by carotid plaque buildup may include stroke, mini-stroke or temporary blindness. Followed for almost three years after surgery, people with micronanoplastics in their carotid plaque were significantly more likely to die or to have a non-fatal heart attack or stroke.

• #1 Volume 4, Number 4—December 1998 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/articles/issue/4/4/table-of-contents

  Chlamydia pneumoniae is a ubiquitous pathogen that causes acute respiratory disease. The spectrum of C. pneumoniae infection has been extended to atherosclerosis and its clinical manifestations. Seroepidemiologic studies have associated C. pneumoniae antibody with coronary artery disease, myocardial infarction, carotid artery disease, and cerebrovascular disease. […] The association of C. pneumoniae with atherosclerosis is corroborated by the presence of the organism in atherosclerotic lesions throughout the arterial tree and the near absence of the organism in healthy arterial tissue. C. pneumoniae has also been isolated from coronary and carotid atheromatous plaques. […] To determine whether chronic infection plays a role in initiation or progression of disease, intervention studies in humans have been initiated, and animal models of C. pneumoniae infection have been developed. This review summarizes the evidence for the association and potential role of C. pneumoniae in cardiovascular disease.

• #1 A multidisciplinary approach for the stratification of patients with carotid artery disease | H2020 | CORDIS | European Commission

  https://cordis.europa.eu/project/id/755320/reporting

  TAXINOMISIS aims to provide novel disease mechanism-based stratification for carotid artery disease patients to address the need for stratified and personalised therapeutic interventions in the current era. […] TAXINOMISIS established a rational new approach for the stratification of carotid artery disease patients by unwinding the pathobiology that underlies carotid artery disease, discriminating distinct disease mechanism-driven states (endotypes) and measurable biological indicators (biomarkers), and developed a multiscale risk stratification tool. […] The molecular mechanisms, the new endotypes, the unique pattern or representation of a molecule’s chemical structure and properties (molecular fingerprints) for high risk, the risk stratification tool and the lab on chip emphasize the improved cost-effectiveness of the new approach and the new research and innovation opportunities for SMEs in the transition to new more personalized medicine principles.

• #2 Management of symptomatic carotid atherosclerotic disease – UpToDate

  https://www.uptodate.com/contents/management-of-symptomatic-carotid-atherosclerotic-disease

  The location most frequently affected by carotid atherosclerosis is the carotid bifurcation, often with extension into the proximal internal carotid artery (ie, the origin). Atherosclerosis of the internal carotid artery at the bifurcation accounts for 10 to 12 percent of all ischemic strokes. […] Definition of symptomatic disease — Symptomatic extracranial carotid atherosclerotic disease is defined as neurologic symptoms that are sudden in onset and referable to the appropriate internal carotid artery distribution (ipsilateral to significant carotid atherosclerotic pathology), including one or more transient ischemic attacks (TIAs) characterized by focal neurologic dysfunction or transient monocular blindness, or one or more ischemic strokes. […] The definition is contingent on the occurrence of carotid symptoms within the previous six months. Remote carotid symptoms should not be considered as indicative of „symptomatic” carotid disease.

• #2 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  Atherosclerotic plaque formation is a chronic insidious process with a number of potential contributors to the formation of such plaques. The definition of atherosclerosis is not only limited to abnormal deposition of lipid but also includes a chronic, complex, inflammatory process. Of particular note, alteration of shear stress is an important initiating factor in atherosclerosis. The process is initiated at the abluminal surface, where metabolic, mechanical, or physical injury causes disruption of endothelial integrity. The resultant endothelial dysfunction can lead to intimal stress associated with an abnormal biochemical signal. Over time, disruption of the tunica media also occurs. […] Endothelial dysfunction is often related to impaired NO-mediated relaxation. The risk factors associated with atherosclerosis, which include diabetes mellitus, hypertension, hyperlipidemia, smoking, as well as genetic predisposition, often potentiate the endothelial dysfunction.

• #2 Pathophysiology and Medical Treatment of Carotid Artery Stenosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4572017/

  Rupture-prone carotid plaques are called vulnerable or unstable plaques which are characterized by active inflammation, extensive accumulation of macrophages, thin cap with a large lipid core, endothelial denudation with superficial platelet aggregation, fissures, and severe stenosis. Vulnerable plaques are more susceptible to rupture when the fibrous cap becomes thin with remodeling of extracellular matrix by matrix metalloproteinase secreted by leukocytes within the intima. The vulnerable plaques are more likely to rupture resulting in thromboembolic events. […] Atherosclerotic plaques generally develop at branch ostia and bifurcation of the common carotid artery into the external and internal carotid artery. The ostium of the internal carotid artery is mostly affected, involving posterior wall of carotid sinus. It also extends into the distal common carotid artery.

• #2 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  The presence of CD40L in atherosclerosis plaque stimulates the expression of tissue factor and potentiates thrombus formation. In addition, exposure of a ruptured plaque to thrombotic material initiates formation of thrombus by activating platelets and the clotting cascade. This cascade of events eventually results in atheroembolism and resultant cerebral, or retinal, ischemia.

• #2 Arteriosclerosis / atherosclerosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569

  Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque also can burst, leading to a blood clot. […] Atherosclerosis is a disease that slowly gets worse. It may begin as early as childhood. The exact cause is not known. It may start with damage or injury to the inner layer of an artery. Artery damage may be caused by: High blood pressure. High cholesterol. High triglycerides, a type of fat in the blood. Smoking or other tobacco use. Diabetes. Insulin resistance. Obesity. Inflammation from an unknown cause or from diseases such as arthritis, lupus, psoriasis or inflammatory bowel disease. […] Once the inner wall of an artery is damaged, blood cells and other substances may collect at the injury site. These substances build up in the inner lining of the artery.

• #2 Stroke victims found to have ’50 times more microplastics’ in their arteries – Manchester Evening News

  https://www.manchestereveningnews.co.uk/news/health/stroke-victims-found-50-times-31582490

  Now, researchers believe these plastic particles in the carotid plaque buildup could be linked to strokes, mini-strokes or temporary blindness. […] Participants with high levels of plaque were found to have nearly 16 times more microplastics in their arteries. Those who had experienced symptoms such as temporary vision loss or stroke had more than 50 times the amount of microplastics as those with no plaque at all. […] „Although it is important to understand the mechanism at play in the pathophysiology of symptomatic carotid atherosclerosis, this association presents a novel potential target for stroke prevention,” Furie added.

• #2 A multidisciplinary approach for the stratification of patients with carotid artery disease | H2020 | CORDIS | European Commission

  https://cordis.europa.eu/project/id/755320/reporting

  From a biological point of view, cellular composition of plaque specimens was assessed using mass cytometry revealing a prevalence of T cells and myeloid cells. […] Ceramides and phosphatidylcholines were identified as potential markers for high-risk patients. […] Five new endotypes were defined by clustering atherosclerotic plaque and plasma patient samples into biologically and clinically relevant disease subtypes namely fibrous, inflammatory, lipo-necrotic, fibro-inflammatory, and fibro-productive. […] Lipo-necrotic and fibro-inflammatory were associated with high risk, inflammatory with intermediate risk and fibrous and fibro-productive with low risk. […] The risk stratification tool is based on a 3-level approach defined by clinical experts. […] The first level utilizes cutting-edge machine learning algorithms to predict more accurately an individual’s risk of carotid artery disease.

• #3 Pathophysiology and Medical Treatment of Carotid Artery Stenosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4572017/

  Besides the general risk factor for atherosclerosis, the fluid dynamics and vessel geometry also play a role in the development of atherosclerosis. Hemodynamic forces at the carotid bifurcation have a role in localization of intimal thickening. Both in vivo and in vitro studies it has been reported that disturbed flow and low-shear conditions produces endothelial dysfunction. […] The mechanism of atherosclerosis in carotid artery is similar to the atherosclerosis in other arterial locations. Reactive oxygen species (ROS) have been implicated in the initiation and progression of atherosclerosis. This hypothesis is universally accepted and it has been described in detail elsewhere by Prasad. ROS increases the expression of cell adhesion molecules including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and endothelial leukocyte adhesion molecule on endothelial cells (ELAMs). Monocyte adherence to endothelial cells is mediated through adhesion molecules. […] Smooth muscle cell proliferation and migration, synthesis of connective tissue and matrix, migration of monocytes and formation of foam cells results in the development and progression of atherosclerosis.

• #3 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  Endothelial dysfunction subsequently triggers atherosclerosis formation and extension. […] The increased endothelial permeability facilitates monocytes to migrate through endothelium and allows low-density lipoprotein (LDL)-cholesterol to enter into the intimal layer, where the LDL is oxidized by the superoxide molecules. The monocytes are then transformed to macrophages and ingest the oxidized LDL particles by phagocytosis. These cells are referred as foam cells. […] The cytokines, growth factors, and adhesion molecules released by the above cells cause further recruitment and migration of the leukocytes and macrophages which potentiate the inflammatory reactions. […] Over time, the intimal layer becomes more permeable to circulating cells and triggers a pro-inflammatory condition with release of cytokines. These cytokines further attract monocytes, macrophages, and T-cells to potentiate the plaque formation.

• #3 Carotid artery disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carotid-artery-disease/symptoms-causes/syc-20360519

  Carotid artery disease occurs when fatty deposits, called plaques, clog the blood vessels that deliver blood to the brain and head (carotid arteries). The clog increases the risk of stroke. […] A buildup of fatty deposits, known as plaques, in the arteries that send blood to the brain cause carotid artery disease. Plaques are clumps that include cholesterol, fat and blood cells that form in the artery. This process is called atherosclerosis. […] Carotid artery disease can lead to stroke through: […] A carotid artery might get so narrow because of atherosclerosis that not enough blood reaches parts of the brain. […] A piece of a plaque can break off and travel to smaller arteries in the brain. The piece of plaque can get stuck in one of these smaller arteries. This blockage cuts off blood supply to part of the brain. […] Some plaques are prone to cracking and forming irregular surfaces on the artery wall. The body reacts as it does to an injury. It sends blood cells that help the clotting process to the area. The result can be a large clot that blocks or slows blood flow to the brain, causing a stroke.

• #3 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  Atherosclerotic plaque formation is a chronic insidious process with a number of potential contributors to the formation of such plaques. The definition of atherosclerosis is not only limited to abnormal deposition of lipid but also includes a chronic, complex, inflammatory process. Of particular note, alteration of shear stress is an important initiating factor in atherosclerosis. The process is initiated at the abluminal surface, where metabolic, mechanical, or physical injury causes disruption of endothelial integrity. The resultant endothelial dysfunction can lead to intimal stress associated with an abnormal biochemical signal. Over time, disruption of the tunica media also occurs. […] Endothelial dysfunction is often related to impaired NO-mediated relaxation. The risk factors associated with atherosclerosis, which include diabetes mellitus, hypertension, hyperlipidemia, smoking, as well as genetic predisposition, often potentiate the endothelial dysfunction.

• #3 A multidisciplinary approach for the stratification of patients with carotid artery disease | H2020 | CORDIS | European Commission

  https://cordis.europa.eu/project/id/755320/reporting

  The second level leverages the power of computational fluid dynamics to simulate blood flow. […] The calculation of wall shear stress enhances the understanding of the mechanical forces contributing to plaque buildup. […] The third level uses computational models to simulate the progression of plaque over time allowing clinicians to forecast plaque growth and identify high risk patients. […] The risk stratification tool was categorized as class IIb according to Regulation (EU) 2017/745 on medical devices. […] TAXINOMISIS managed to characterize the gene expression profile of symptomatic and asymptomatic patients, to determine the cellular composition of atherosclerotic plaques, to assess the predictive value of ceramides and extracellular vesicle biomarkers in carotid artery disease, to identify five new endotypes and circulating biomarkers associated with plaque erosion and rupture.

• #3 AI in personalised medicine: Better risk identification, prevention and treatment of carotid artery disease | TAXINOMISIS Project | Results in Brief | H2020 | CORDIS | European Commission

  https://cordis.europa.eu/article/id/446042-ai-in-precision-medicine-better-risk-identification-prevention-and-treatment-of-carotid

  By harnessing the power of AI, researchers have developed a novel disease mechanism-based stratification for carotid artery disease patients, unlocking tailored therapeutic interventions. […] Carotid artery disease is caused by the narrowing or blockage of the neck arteries due to plaque build-up (atherosclerosis). […] The key objective of the EU-funded TAXINOMISIS project is to develop a novel model that can be employed to categorise patients based on their risk of developing carotid artery disease and experiencing cerebrovascular events manifested as stroke, transient ischaemic attack or transient loss of vision. […] The TAXINOMISIS risk stratification tool assesses the risk of carotid artery disease in individuals by using non-imaging data as input to evaluate the likelihood of high-risk plaques and the potential development of the disease.

• #4 Carotid artery stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Carotid_artery_stenosis_pathophysiology

  Embolism of atherosclerotic lesions in the carotid is the most common mechanism of stroke in patients with carotid artery disease. Thrombosis of the cerebral arteries is also a possible, less common cause of stroke. […] Atherosclerotic lesions are commonly located within 2 cm from the bifurcation of the common carotid artery, usually on the posterior wall of the artery. These plaques can extend caudally into the common carotid artery. […] The presence of atherosclerotic plaque is a risk for developing a stroke, regardless of its location. […] In addition to compromising the flow to the brain, the plaque can rupture and a superimposed thrombus can develop on the atheroma further exacerbating the stenosis. […] The emboli then travels upstream until it lodges into a cerebral artery compromising blood supply to the associated territory. […] When the internal carotid artery is totally occluded, it can lead to slow flow or thrombosis. The severity of symptoms depend on the adequacy of the collateral circulation. […] Occurs many months after carotid occlusion. From propagation of the thrombus or embolization of the clot upstream.

• #4 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  The pathology of carotid stenosis begins with fatty streak formation, followed by production of atheromatous fibrous plaque. Accumulation of foam cells and SMCs in the intimal layer and production of extracellular matrix by the foam cells creates a fatty streak, elevates the endothelium, and initiates the formation of atherosclerotic plaque. […] The lipid-rich core is soft, avascular, hypocellular, and devoid of collagen. Apoptosis of foam cells and SMCs results in the formation of an unstable lipid core and the fragile and rupture-prone fibrous cap. […] Chronic ongoing inflammation in a noncalcified plaque is the key element of atherosclerotic plaque vulnerability and disruption. On the other hand, plaque calcification is an indicator of a stable plaque less likely to be associated with thromboembolism.

• #4 A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism

  https://atm.amegroups.org/article/view/72884/html

  This hypothesis is supported by data coming from TCD studies. […] Plaques that are more prone to cause distal embolization and subsequent TIA and stroke occurrence are qualified as vulnerable. […] The pathogenesis of WS infarcts remains debated. […] However, evidence of the role of embolism in the pathophysiology of WS infarcts has been documented early in autopsy studies showing the presence of microemboli including cholesterol crystals in arteries supplying WS zones. […] A dichotomized approach is nevertheless likely too simplistic. Caplan et al. proposed that hemodynamic compromise and embolism may be intimately intertwined. Thus, reduced perfusion may hamper washout or clearance of emboli, particularly within the WS zone or make this brain area, with marginal perfusion, more vulnerable to the effect of microemboli. […] In any case, these two mechanisms appear to contribute, solely or synergistically, to all subtypes of deep WS infarcts according to studies combining brain perfusion mapping and MES assessment in patients with recently symptomatic carotid stenosis.

• #4 AI in personalised medicine: Better risk identification, prevention and treatment of carotid artery disease | TAXINOMISIS Project | Results in Brief | H2020 | CORDIS | European Commission

  https://cordis.europa.eu/article/id/446042-ai-in-precision-medicine-better-risk-identification-prevention-and-treatment-of-carotid

  The tool can estimate the risk of plaque rupture, which is a serious condition associated with blood clots inside blood vessels. […] The risk stratification tool may also aid medical professionals in comprehending the diseases fundamental mechanics, which might eventually lead to better treatment plans.

• #5 Carotid Artery Disease – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/arterial/carotid-artery-disease/

  Carotid artery disease refers to the build-up of atherosclerotic plaque in one or both common and internal carotid arteries, resulting in stenosis or occlusion. […] The pathophysiology of carotid artery disease is as for atheroma elsewhere, starting with a fatty streak, accumulating a lipid core and formation of a fibrous cap. The turbulent flow at the bifurcation of the carotid artery predisposes to this process specifically at this region. […] Carotid artery disease is usually classified radiologically by the degree of stenosis.

• #5 Carotid artery stenosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1205

  Carotid artery stenosis is a narrowing of the lumen of the carotid artery. Approximately 10% to 15% of all ischemic strokes are associated with carotid artery stenosis. […] Atherosclerotic plaque in the cervical carotid artery is the most common cause. Plaque disruption and atheroembolization into the intracranial circulation is the most common mechanism for stroke. […] The unique hemodynamics at the carotid bifurcation predisposes this area to atherosclerosis. A small percentage of plaques may rupture and embolize to occlude intracranial arteries, causing a transient ischemic attack or stroke, or occlude retinal arteries to cause transient monocular blindness (amaurosis fugax) or retinal strokes.

• #5 A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism

  https://atm.amegroups.org/article/view/72884/html

  Atherosclerotic carotid artery stenosis causes about 1020% of all ischemic strokes through two main mechanisms: hemodynamic impairment in case of significant stenosis and thromboembolism from an atherosclerotic plaque regardless of the degree of stenosis. […] While it is likely that some ischemic strokes associated with carotid artery disease result from hypoperfusion, the majority of such strokes appear to result from embolization from a vulnerable atherosclerotic plaque or acute occlusion of the carotid artery and propagation of thrombus distally. […] These data suggest that hemodynamic impairment may play a role in the occurrence of stroke in patients with carotid stenosis. […] Beyond the degree of stenosis and its potential hemodynamic impairment, carotid plaques, especially vulnerable plaques, cause mostly downstream ischemic stroke through a microembolic mechanism.

• #6 Carotid artery stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Carotid_artery_stenosis_pathophysiology

  Embolism of atherosclerotic lesions in the carotid is the most common mechanism of stroke in patients with carotid artery disease. Thrombosis of the cerebral arteries is also a possible, less common cause of stroke. […] Atherosclerotic lesions are commonly located within 2 cm from the bifurcation of the common carotid artery, usually on the posterior wall of the artery. These plaques can extend caudally into the common carotid artery. […] The presence of atherosclerotic plaque is a risk for developing a stroke, regardless of its location. […] In addition to compromising the flow to the brain, the plaque can rupture and a superimposed thrombus can develop on the atheroma further exacerbating the stenosis. […] The emboli then travels upstream until it lodges into a cerebral artery compromising blood supply to the associated territory. […] When the internal carotid artery is totally occluded, it can lead to slow flow or thrombosis. The severity of symptoms depend on the adequacy of the collateral circulation. […] Occurs many months after carotid occlusion. From propagation of the thrombus or embolization of the clot upstream.

• #6 Carotid atherosclerotic disease: A systematic review of pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9578307/

  Carotid stenosis is an important contributor to ischemic stroke risk with resultant significant impact on neurological disability and death in adults and with worldwide implications. […] Understanding of the pathogenesis of carotid atherosclerosis or stenosis is important in management of carotid stenosis. Atherosclerotic plaque formation is a chronic insidious process with a number of potential contributors to the formation of such a plaque. The definition of atherosclerosis is not simply limited to abnormal deposition of lipid but also includes a chronic, complex, inflammatory process. Molecularly, in atherosclerosis, there is decreasing nitric oxide (NO) bioavailability, activity and/or expression of endothelial NO synthase, or increasing degradation of NO secondary to enhanced superoxide production. These above changes cause endothelial dysfunction leading to formation of foam cell followed by formation on lipid plaque. After lipid plaque formation, stable or unstable atherosclerotic plaque is formed depending on the calcium deposition over the lipid plaque.

• #7 Relevance of External Carotid Artery Disease in Internal Carotid Artery Occlusion | Thoracic Key

  https://thoracickey.com/relevance-of-external-carotid-artery-disease-in-internal-carotid-artery-occlusion/

  Internal carotid artery (ICA) occlusion has long been thought to carry a poor prognosis despite what is often an asymptomatic presentation. […] The mechanism of acute stroke after ICA occlusion is typically embolism to the middle cerebral artery (MCA) circulation, thrombus extension past the ophthalmic artery into the circle of Willis, or hemodynamic insufficiency in association with either an isolated hemisphere or diffuse extracranial cerebrovascular disease. […] Stroke at an interval following ICA occlusion may be caused by similar mechanisms but can also arise from a diseased external carotid artery (ECA) or embolization from a remnant ICA cul-de-sac containing thrombus and/or platelet or fibrin debris. […] The ECA can serve as the major cerebral collateral in the setting of ICA occlusion, and a proximal ECA stenosis can have a hemodynamic impact on cerebral perfusion.

• #7 Carotid artery stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Carotid_artery_stenosis_pathophysiology

  Embolism of atherosclerotic lesions in the carotid is the most common mechanism of stroke in patients with carotid artery disease. Thrombosis of the cerebral arteries is also a possible, less common cause of stroke. […] Atherosclerotic lesions are commonly located within 2 cm from the bifurcation of the common carotid artery, usually on the posterior wall of the artery. These plaques can extend caudally into the common carotid artery. […] The presence of atherosclerotic plaque is a risk for developing a stroke, regardless of its location. […] In addition to compromising the flow to the brain, the plaque can rupture and a superimposed thrombus can develop on the atheroma further exacerbating the stenosis. […] The emboli then travels upstream until it lodges into a cerebral artery compromising blood supply to the associated territory. […] When the internal carotid artery is totally occluded, it can lead to slow flow or thrombosis. The severity of symptoms depend on the adequacy of the collateral circulation. […] Occurs many months after carotid occlusion. From propagation of the thrombus or embolization of the clot upstream.

• #8 Relevance of External Carotid Artery Disease in Internal Carotid Artery Occlusion | Thoracic Key

  https://thoracickey.com/relevance-of-external-carotid-artery-disease-in-internal-carotid-artery-occlusion/

  Studies have demonstrated that the ECA contributes to cerebral blood flow compensation in up to 80% of patients with a symptomatic ICA occlusion. […] In addition, several studies have demonstrated improvement in cerebral perfusion following restoration of ECA hemodynamics to normal. […] The ECA can provide significant ipsilateral collateral blood flow, but it can also be a source of significant-sized collaterals through which atherosclerotic debris can reach the intracranial vessels. […] Given that the ECA does not always develop as an important collateral pathway, in the absence of clear embolic events related to a diseased ECA or occluded ICA, hemodynamic assessment of the collateral blood supply increases the accuracy of the decision-making process.

• #8 Atherosclerotic Disease of the Carotid Artery: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/463147-overview

  Atherosclerosis is a diffuse, degenerative disease of the arteries that results in the formation of plaques composed of necrotic cells, lipids, and cholesterol crystals. […] Currently, embolization is considered the most common mechanism causing ischemic strokes from atherosclerotic lesions in the carotid bulb. Thrombosis and low flow are other possible mechanisms. […] Stroke is one of the most devastating complications of carotid stenosis. However, carotid stenosis is not the only cause of stroke. In fact, among patients with asymptomatic stenosis of 60-99%, as many as 45% of strokes may be caused by lacunar infarcts or cardiac emboli.

• #9 Carotid Artery Stenosis: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/16845-carotid-artery-disease-carotid-artery-stenosis

  Carotid artery stenosis is often diagnosed after you’ve experienced symptoms of a stroke. […] The main goal of carotid artery stenosis treatment is to halt the progression of the disease. […] Carotid artery stenosis can be dangerous if it’s not caught and treated quickly. This condition can cause a stroke, which can lead to death or disability.

• #10 Carotid  | Fulton Vascular

  http://www.fultonvascular.com/carotid.html

  The next step is to start an anti platelet or blood thinning agent such as Aspirin. Altering all of these risk factors is designed to improve the risk of having a stroke or mini strokes in the future. Once the risk factors have been adjusted and the right medication has been started then some consideration should be given to carotid artery surgery. Surgery on the carotid artery is designed to remove the inner, irregular layer by separating it from the rest of the artery. Once it has been removed the artery is closed and hopefully the blood flow will be less turbulent. This procedure is called carotid endarterectomy. […] Carotid disease is diagnosed by ultrasound and categorised as mild moderate and severe. In patients who have had a stroke or mini stroke before and who have severe disease carotid endarterectomy is recommended. In patients who have never had a stroke or mini stroke the benefits are more marginal however surgery should be considered in male patients with severe disease under the age of 75 and female patients with severe disease under the age of 70. Surgery is not considered for everybody as it has a small risk of producing a stroke itself. That risk is about 3% for all surgery. The result is that the risk of surgery has to be balanced against the risk of leaving the patient being treated only with risk factor modification and medication. […] Carotid stenting is another alternative treatment however some studies have suggested that the stroke rate from treatment may not be quite as good as surgery.

• #11 Carotid and Vertebral Artery Stenosis – Vascular Diseases, Peripheral – Cardiovascular Diseases – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.2.28.

  Atherosclerosis is the cause of 90% of all cases of stenosis or occlusion of the carotid arteries and most cases of stenosis of the vertebral arteries; rare causes include postradiotherapy stenosis, systemic vasculitis, spontaneous or traumatic artery dissection, and fibromuscular dysplasia. […] Carotid or vertebral artery stenosis may be symptomatic or asymptomatic. […] Recommended treatment of carotid artery stenosis: Table 1. […] Medical management is usually preferred over a surgical or endovascular intervention for patients with asymptomatic carotid stenosis, although surgery or stenting could be considered on an individual basis if the procedural risk is low and the patients life expectancy is 5 years. […] Invasive Treatment […] Carotid artery stenosis: Surgical removal of the atherosclerotic plaques that cause the stenosis (endarterectomy) or endovascular angioplasty with stent implantation. Treatment should be started as soon as possible after the symptomatic event to reduce the risk of recurrent stroke.

• #12 Carotid Artery Disease | Carotid Artery Stenosis | MedlinePlus

  https://medlineplus.gov/carotidarterydisease.html

  Your carotid arteries are two large blood vessels in your neck. They supply your brain and head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because of atherosclerosis. Atherosclerosis is the buildup of plaque, which is made up of fat, cholesterol, calcium, and other substances found in the blood. […] Carotid artery disease is serious because it can block the blood flow to your brain, causing a stroke. Too much plaque in the artery can cause a blockage. You can also have a blockage when a piece of plaque or a blood clot breaks off the wall of an artery. The plaque or clot can travel through the bloodstream and get stuck in one of your brain’s smaller arteries. […] Imaging tests can confirm whether you have carotid artery disease.

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