Cola C, Clementi E, Biondi-Zoccai G, Sangiorgi G
Department of Cardiology, University of Rome Tor Vergata, Rome, Italy.
Acta Chir Belg. 2007 Mar-Apr;107(2):129-42.
Stroke is the second cause of mortality in industrialized countries. Atherosclerotic plaque rupture with atheromatous debris distal embolization is the pathogenetic mechanism responsible for cerebrovascular events due to atherosclerotic carotid disease. Plaque composition rather than lesion burden seems to be the determinant factor producing rupture and subsequent thrombosis. Histologic features of vulnerability are : a large lipid core, a thin fibrous cap, and an inflammatory infiltrate rich of monocytes and macrophages. In the clinical practice, it is difficult to predict the risk of experiencing a major cerebrovascular events especially in asymptomatic patients. New invasive techniques such as intravascular ultrasound with termography, optical coherence tomography, fotons spectroscopy and elastography have been developed to detect atherosclerotic lesion tissue composition. However, such techniques are difficult to apply on a large scale basis in primary prevention. On the contrary, new serologic biomarkers such as Pregnancy Associated Plasma Protein-A, Lp-PLA2, Interleukin-6, Interleukin-12, metalloproteinases, lipoprotein-(a), and plaque oxidative products have been recently proposed for screening general and high risk population. The present paper will briefly review the current histologic characteristics of vulnerable plaque and the new imaging tools proposed for its detection, focusing on the most recent serologic biomarkers evaluated in the clinical practice to increase our accuracy in predicting not only the plaque but moreover the patient at risk for an acute cerebrovascular event.
中风是工业化国家的第二大致死原因。动脉粥样硬化斑块破裂伴粥样物质远端栓塞是动脉粥样硬化性颈动脉疾病导致脑血管事件的发病机制。斑块成分而非病变负荷似乎是导致破裂及随后血栓形成的决定性因素。易损斑块的组织学特征包括：大的脂质核心、薄的纤维帽以及富含单核细胞和巨噬细胞的炎性浸润。在临床实践中，尤其是在无症状患者中，很难预测发生重大脑血管事件的风险。已开发出诸如血管内超声联合血管造影、光学相干断层扫描、光子光谱学和弹性成像等新的侵入性技术来检测动脉粥样硬化病变的组织成分。然而，此类技术难以在一级预防中大规模应用。相反，最近有人提出了新的血清学生物标志物，如妊娠相关血浆蛋白-A、脂蛋白磷脂酶A2、白细胞介素-6、白细胞介素-12、金属蛋白酶、脂蛋白(a)和斑块氧化产物，用于筛查普通人群和高危人群。本文将简要回顾易损斑块当前的组织学特征以及为检测易损斑块而提出的新的成像工具，重点关注在临床实践中评估的最新血清学生物标志物，以提高我们不仅预测斑块而且预测急性脑血管事件高危患者的准确性。
