Pende Aldo, Dallegri Franco
Clinic of Internal Medicine 1 Department of Internal Medicine, University of Genoa School of Medicine, Viale Benedetto XV, 6, 16132 Genoa, Italy.
Curr Vasc Pharmacol. 2015;13(2):173-81. doi: 10.2174/15701611113116660163.
Stroke, a leading cause of death or disability worldwide, is frequently dependent on the rupture of carotid atherosclerotic plaques. It is therefore extremely important to study the mechanisms of formation, progression and eventually rupture of the plaques. Vulnerability of the plaque, the intrinsic tendency to lose its integrity and consequently to induce a dramatic atherothrombotic or embolic event, is still an elusive concept because many players are involved and the clinical picture is frequently the sum of different contrasting (pro-inflammatory and anti-inflammatory) phenomena. This review will discuss recent advancements in the comprehension of this topic. In particular inflammatory activation at the level of the carotid plaque will be described in the attempt to underline the main factors for the formation, the chronic persistence and the risk of rupture. Since these topics can be studied in humans only with plaque samples obtained following endarterectomy, research has tried to evaluate the role of different biomarkers which could be useful for the definition of the vulnerability of a carotid plaque, or, with more clinical relevance, of a patient; some recent results from our group will be discussed. A significant help for clinical decisions may also come from imaging tools, both well established ultrasound and more sophisticated options, such as magnetic resonance and positron emission tomography. This large amount of scientific information should allow the development of new therapeutic approaches for the effective prevention of cerebrovascular events.
中风是全球主要的死亡或致残原因，通常取决于颈动脉粥样硬化斑块的破裂。因此，研究斑块的形成、进展以及最终破裂的机制极为重要。斑块的易损性，即失去完整性并因此引发严重动脉粥样硬化血栓形成或栓塞事件的内在倾向，仍然是一个难以捉摸的概念，因为涉及许多因素，而且临床情况往往是不同的（促炎和抗炎）现象相互矛盾的总和。本综述将讨论该主题理解方面的最新进展。特别是将描述颈动脉斑块水平的炎症激活，以强调斑块形成、慢性持续存在和破裂风险的主要因素。由于这些主题只能通过动脉内膜切除术后获得的斑块样本在人体中进行研究，因此研究试图评估不同生物标志物的作用，这些生物标志物可能有助于定义颈动脉斑块的易损性，或者更具临床相关性地定义患者的易损性；将讨论我们小组最近的一些结果。成像工具，无论是成熟的超声还是更先进的选择，如磁共振成像和正电子发射断层扫描，也可能对临床决策有很大帮助。这些大量的科学信息应该能够推动新治疗方法的开发，以有效预防脑血管事件。
